Multiple Sclerosis

Question 1

Definition

Answer 1

Acquired, chronic, immune mediated, inflammatory condition of the CNS.
Causes UMN problems due to demyelination, gliosis, secondary neurological damage

Question 2

Relapsing Remitting MS

Answer 2

Most common at onset
Episodes/exacerbations of symptoms and followed by recovery .
After several relapses may progress to SPMS

Question 3

Secondary Progressive MS

Answer 3

Disease changes from RRMS

Worsen neurological function w/o relapses

Question 4

Primary progressive MS

Answer 4

Steady progression and worsening of the disease from the onset, w/o remissions

Question 5

Risk Factors

Answer 5

Low vitamin D levels
Cigarette smoking
Obesity in early life
Infections: EBV
FH

Question 6

Optic Neuritis, Internuclear Ophthalmoplegia

Answer 6

Pain on eye movement
Decreased VA/colour vision centrally
RAPD
Central scotoma
Swollen optic disc
Treated with steroids

Question 7

Investigations

Answer 7

LP: oligoclonal bands (B cells produces this)
VEPs
MRI

Question 8

Diagnosis

Answer 8

Clinical diagnosis:

• 2 or more episodes
• 1 episode with an abnormal MRI

Question 9

Management

Answer 9

Corticosteroids

Disease modifying treatments

Question 10

Acute Relapses

Answer 10

Methylprednisolone

Question 11

Disease Modifying Treatments

Answer 11

Interferon beta

Question 12

Second line treatment

Answer 12

Fingolimod

Question 13

Third line therapy

Answer 13

Natalizumab

Question 14

Conservative management

Answer 14

Physiotherapy

Question 15

Symptoms

Answer 15

Spasticity: when treated it unmasks weakness and ataxia
Ataxia
Tremor
Bladder dysfunction
Fatigue