Multiple Sclerosis Flashcards
What is multiple sclerosis
- this is an autoimmune inflammatory disease that attaches myelinated axons in the centre nervous system
How do you recognise MS
- patients medical history
- physical examination
What is an episode of multiple sclerosis defined as when investigating multiple sclerosis
- Current neurological symptoms or a previous neurological episode lasting at least 24 hours without evidence of infection, fever or encephalopathy
What are the most common symptoms of multiple sclerosis
- sensory and motor problems - can experience numbness or tingling down arms and legs, or an electric current sensation down he back of the legs or useless hand syndrome
- vision problems; vision blurriness or loss or diplopia
- slow progressive or subacute motor defeicts
What symptoms of MS occur in less than 5% of patients
- Bladder dysfunction
- Heart intolerance
- Paroxysmal symptoms
- Pain
- Movement disorders
- Dementia
When do patients with MS tend to feel worse
People tend to feel worst when there is heat, temperature change in their symptoms and they can have recurrence of symptoms typically the vision loss, but other things can show up and when they cool down this then disappears
- this is because heat causes nerves to conduct less efficiently
what are the types of MS that can occur
relapsing remitting
primary progressive
secondary progressive
describe the three types of MS that can occur
relapsing remitting
- this is when an attack will occur but then go back to baseline - this is the most common type and affects 75-90% of patients
primary progressive
- patient never relapses and progressively gets worse
secondary progressive
- between relapses the disease gets worse
even if the patient does not …
even if patient does not have a lot of relapses the disease may be progressing sub clinically.
what do we mean by relapse in MS
- inflammation waves entering the brain
what part of the brain do lesions tend to be in in MS
- periventricular, they can be in any part of the brain but need to have a periventricular lesions
- there are some cases in which the spinal cord will have a lesion and the brain won’t
What type of MRI scan can be used for spotting inflammation in multiple sclerosis
T2/FLAIR lesions
what contrast can be used to enhance the areas of inflammation
- gadolinum
describe what the MRI has to show for MS to be diagnosed
T2/FLAIR lesions disseminated in space: (>1 area) in >= 2 CNS areas
- lesions can be in periventricular, juxtacortical, infratentorial, or spinal cord
- *Lesion in corpus callosum is also indicative of MS because they are rare in other conditions
and
- *T2/FLAIR lesions disseminated in time (ie, occurring at different points in time)
- e.g. 1 lesion at baseline and then, on follow-up MRI, have a new T2 and/or Gd-enhancing lesion
what else can the MRI show in MS
can show brain atrophy
How do you diagnose MS
MRI and lumbar puncture
How does a lumbar puncture show that you have MS
- done in sterile environment with atruamtic needle which means that there is no damage to the dura
- it compares components of the CSF to the plasma (such as presence of blood cells and lymphocytes)
- measures neurofilaments - if the neurofilamnets are high than it is indicative of ongoing nerve loss
what are neurofilaments
= neurofilaments are the protein component of axons
what are olgioclonal bands
- can see olgiocloncal bands in the CSF and not in the plasma = this is a hallmark of chronic inflammatory process
How do you diagnose MS
- Neurological symptoms need to occur in more than one place in the CNS (brain, spinal cord, optic nerve) (dissemination in space) AND
- It needs to be a chronic condition i.e. two different points (dissemination in time).
- Rule out all other diagnoses.
what are the two important things in diagnosis of MS
- Time is important in diagnosis – by definition it is a chronic disease so you have to show that it is not a one off therefore lesions should be seen at two different times
- it should not only affect one part of the nervous system, there should be lesions in different part of the nervous system
Why do we have a diagnostic criteria
- We have a diagnostic criteria so we can have a homogenous population so we can test a drug or treatment
- sometimes you have to be able to make a diagnosis so that we can treat
- to rule out other possible diagnosis
what are other differential illnesses in comparison to MS
- Cerebrovascular disease
- Syphilis
- Lyme borreliosis
- SLE
- Vitamin B12 deficiency
- Rare hereditary diseases
describe the genetic component of MS
There is a genetic component but it is not very relevant (in terms of producing offspring chances are relatively low).
