Multiple sclerosis Flashcards
UMN or LMN?
UMN
Pathology?
Innate and adaptive immunity attacking oligodendrocytes
Demyelination and improper remyelination
Also some axonal damage
Character of the disease?
Relapsing and remitting
65% of R+R patients will go on to have secondary progressive MS
Symptoms of optic neuritis:
Reduced VA and colour vision
RAPD
Central scotoma (blind spot in centre of vision)
Papilloedema
What does internuclear ophthalmoplegia suggest?
In a young patient it is characteristic of MS
In an old patient it suggests stroke
What causes internuclear ophthalmoplegia?
Lesion of the medial longitudinal fasciculus
What is Lhermitte’s sign and what does it suggest?
Neck flexion sends pain down the back
MS in the young
Or B12 deficiency
What does MRI reveal in an MS patient?
Large ventricles
WM lesions around ventricles and more distal (dark lesions in T1)
Bright optic nerves from optic neuritis
Dorsan’s fingers - lesions coming out of ventricles + corpus callosum
What does lumbar puncture of an MS patient show?
Oligomeric bands
B cells
Diagnosis:
Show chronicity:
Multiple attacks
OR one attack with multiple lesions on MRI
OR one attack + oligomeric bands
Visual symptoms of MS:
Optic neuritis
Optic atrophy (pale disc)
Uhtoff’s: worse vision with raised body temperature
Internuclear opthalmoplegia
Cerebellar symptoms of MS:
Ataxia: acute relapse > presenting
Tremor
Motor symptoms of MS:
Spastic weakness most commonly in the legs
Sensory symptoms of MS:
Pins and needles feeling
Numbness
Trigeminal neuralgia
Lhermitte’s syndrome
What is primary progressive MS?
MS which has a later onset (40-50s)
Affects men and women equally
Constantly gets worse
What is secondary progressive MS?
Relapsing-remitting course but with neurological deterioration
Developed neurological signs and symptoms between relapses
Gait and bladder disorders
Treatment of an acute relapse?
Only treat if causing distress/limiting activities
Exclude underlying worsening of symptoms - check urine
High dose steroids can be given 500mg for 5 days or 1g for 3 days to reduce length of relapse
Disease modifying drugs:
Beta-interferon reduces relapse rate by 30%
Glatiramer acetate is an ‘immune decoy’
Natalizumab stops leukocytes crossing BBB
Fingolimod prevents lymphocytes leaving LNs
Other biologics
Risk of drugs?
Wrong drug can kill - only give if at that stage of the disease
Risk of treating MS?
Progressive multifocal leukoencephalopathy (PML)
Oppurtunistic viral infections in the brain
What is NEDA?
No perceived relapses
No active T2 lesions
No active T1 Gd and lesions
No confirmed disability progression
