Multiple Sclerosis Flashcards
What is MS?
An idiopathic demyelinating disease of the CNS
What symptoms can occur as a result of demyelination in MS?
Loss of neurological function: weak legs, visual loss, urinary incontinence
What is the onset of MS?
Deficits develop gradually, last fro more than 24 hours and may gradually improve over days to weeks
What are the subtypes of MS?
Relapsing remitting
Primary progressive
Secondary progressive
Give examples of syndromes which may develop into MS?
Optic neuritis
Clinically isolated syndromes
Transverse myelitis
Radiological isolated syndromes
Describe the onset of optic neuritis?
Painful visual loss comes on over a few days. May resolve after a few weeks
What are the symptoms of transverse myelitis?
Weakness
Sensory loss
Incontinence
What is transverse myelitis?
Inflammation of the spinal cord
When can MS be definitively diagnosed?
Evidence of 2 or more episodes of demyelination which are disseminated in space and time
What are the possible causative factors of MS?
Genetic factors
Sunlight / vitamin D exposure
Viral trigger (possibly EBV)
Smoking
When should MS be suspected?
Neurological symptoms which develop over a few days
History of transient neurological symptoms that have lasted more than 24 hours and spontaneously resolved
‘hidden relapses such as optic neuritis, false diagnosis of Bell’s palsy or labrynthitis, sensory symptoms and bladder symptoms
What are the possible visual symptoms of MS?
Nystagmus
Optic neuritis
Diplopia
What are the possible central symptoms of MS?
Fatigue
Cognitive impairment
Depression
Unstable mood
What are the possible sensation symptoms of MS?
Pain
Hypoesthesias
Paraesthesias
What are the possible muscoloskeletal symptoms of MS?
weakness
spasms
ataxia
What are the possible throat/speech symptoms of MS?
Dysarthria
Dysphagia
What are the possible bowel symptoms of MS?
Incontinence
Diarrhoea or constipation
What are the possible urinary symptoms of MS?
Incontinence
Frequency or retention
When should conditions other than MS be expected?
Sudden onset Peripheral signs Major cognitive involvement reduced level of consciousness Prominent seizures Pyrexia/evidence of infection Normal MRI scan
What tests should be conducted to help with the diagnosis of MS?
MRI Lumbar puncture Bloods Visual evoked potentials CXR
What evidence should be seen on MRI to confirm a MS diagnosis?
Demyelination in 2 regions to indicate dissemination in space
If enhancing and non-enhancing areas of demyelination are seen this can indicate dissemination in time
Oligoclonal bands are seen in MS. What are oligoclonal bands?
Immunoglobulin bands seen in blood and spinal fluid after protein electrophoresis. Presence of these bands in CSF but not in blood suggests that there is immunoglobulin production in the CNS.
Other blood tests are used to exclude other causes of the presentation in possible MS. What blood tests are used?
B12/folate Serum ACE Lyme serology ESR/CRP ANA/ANCA/Rheumatoid factor Aquaporin 4 antibodies
How is a relapse in MS defined?
Involves a new neurological deficit that lasts for more than 24 hours in the absence of pyrexia or infection
What is a pseudo-relapse in MS?
Re-emergence of previous neurological symptoms or signs related to an old area of demyelination in the context of heat or infection
All MS reloaded require treatment. T/F?
True
What steroid regimen can be given to treat a relapse of MS?
1g of methylprednisolone for 3 days or 500mg of oral methylprednisolone for 5 days
What should be given alongside steroids to treat an MS relapse?
A PPI for gastroprotection
What risks are associated with alemtuzumab, used to treat MS?
Secondary autoimmune problems
What risks are associated with natalizumab, used to treat MS?
Fatal PML if the patient is infected with the JC virus.
How is natalizumab administered in MS?
Monthly infusions
How is fingolimod administered in MS?
Daily tablet
What risks are associated with the use of fingolimod in MS?
Risk of infections
Slow heart rate
What risks are associated with the use of dimethyl fumarate in MS?
Low white cell counts
Risk of infection
How is dimethyl fumarate administered in MS?
Twice daily tablet
What is the action of cladribine in MS?
Targets B cells
What type of MS can autologous haemopoetic stem cell transplant be used for?
Aggressive relapsing remitting MS
What older treatments can be used in MS?
Beta interferon and Copaxone
How are beta interferon and Copaxone administered in the treatment of MS?
Injections daily
What is the potential treatment for primary progressive MS?
Ocrelizumab
What is the potential treatment for secondary progressive MS?
Siponimod
What is the advanatage to giving biotin in MS?
Some symptom relief, mild improvement in power, gives energy to damaged nerve cells
