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NEUROLOGY > MULTIPLE SCLEROSIS > Flashcards

MULTIPLE SCLEROSIS Flashcards

1
Q

What is MS?

A
  • inflammatory DEMYELINATING d.o of the cns
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2
Q

When is the usual time of onset of MS and in whom?

A
  • females

- 30s and 40s

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3
Q

How does MS present as on imaging?

A

MRI

- plaques disseminated in time and place

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4
Q

What predisposes you to MS?

A
  • a monozygotic twn= 1 in 3 chance
  • 1st degree relative== 12% chance
    GENETIC makeup is HUGE in pathology
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5
Q

Main clinical fts of MS?

A
  1. optic neuritis
  2. pyramidal dysfxn (h/t and weakness)
  3. sensory symptoms
  4. Lr urinary tract dysfxn
  5. cerebellar & brain stem fts
  6. cognitive impairment
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6
Q

What occurs from pyramidal dysfxn?

A
  • incr. TONE
  • spasticity
  • weakness
  • involves EXTENSORS of UPPER limbs
  • flexors of lower limbs
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7
Q

What occurs with optic neuritis?

A
  • PAINFUL vision loss

- most will improve (1-2weeks)

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8
Q

WHat is the 1st presentation of MS?

A
  • pain of moving eyes

- i.e. OPTIC NEURITIS

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9
Q

How to test for optic neuritis?

A
  • shine light in both the eyes (alternating between the 2)
    —-find the eye with the pathology NOT constricting with the light
    = RAPD (relative afferent pupillary defect)
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10
Q

Are sensory symtoms present in MS?

A

YES

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11
Q

What are some sensory symtptoms?

A
  • PAIN
  • paraesthesia (burning feeling/ water going down the leg)
  • DORSAL column loss (VIBRATION and PROPRIOCEPTION)
  • numbness
  • trigeminal neuralgia
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12
Q

What are some symptoms of cerebellar dysfxn?

A
  • ataxia
  • nystagmus
  • dysarthria
  • intention tremor
  • past pointing
  • pendular reflexes
  • dysdiadokinesis
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13
Q

How does brain stem dysfxn present as?

A
  • DIPLOPIA (VI nerve palsy)

- facial weakness (VII palsy)

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14
Q

What is affected in internuclear ophthalmoplegia to result in DIPLOPIA?

A
  • pathology of the MEDIAL LONGITUDINAL FASCICULUS

distorts the binocular vision

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15
Q

What is seen clinically with INO?

A
  • failure of ADDUCTION
    > DIPLOPIA
    ——nystagmus in normal abducting eye
    —lag
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16
Q

WHat urinary tract symptoms are seen?

A
  • nocturia
  • freq. (d.t irritability(
  • urgency
  • URGE incontinence
  • retention (d.t incr. tone)
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17
Q

How do you manage fatugability in MS?

A
  • amantadine
  • MOdafinil is SLEEPY
  • HYPERBARIC oxygen
18
Q

How is the urinary tract dysfxn managed?

A
  • bladder drill
  • anti-cholinergics (OXYBUTIN–> retention causing detrusor overactivity)
  • desmopressin (given for LONG journeys)
  • catheterisation
19
Q

Criteria for dx MS?

A

at least 2 episodes suggestive of demyelination

dissemination in time and place

20
Q

What ivx can be done for confirming MS dx?

A

-Clinical
- MRI
CSF
- NEUROPHYSIOLOGY
- BLOODTEST

21
Q

What are some ddx for MS?

A
  • vasculitis
  • granulomatous disorder
  • vascular disease
  • tumor
  • infection (HIV, LYME)
  • metabolic disease (B12 folate def.)
22
Q

What blood tests can be done?

A
  1. plasma viscosity, FBC and CRP should be NORMAL
  2. renal, liver and bone profile
  3. auto anti-body screen
  4. borellia, HIV, syphilis serology
  5. B12 and folate
  6. Vitamin D
23
Q

What should be looked for in CSF?

A
  1. raised proteins
  2. incr. proportion of immunoglobulins
  3. presence of oligoclonal bands in the CSF
    - in 90% of cases
24
Q

How variable is relapse?

A
  • could happen in one year or 10 years
25
Q

What does prophylactic rx for MS entail?

A
  • initiation of disease modifying therapy
  • escalation to second line
  • MRI
26
Q

How is a MILD acute exacerbation treated?

A

symptomatically

27
Q

How is a MODERATE acute exacerbation treated?

A

ORAL steroids

- oral methylprednisolone (0.5g x 5 days)

28
Q

How is a SEVERE acute exacerbation treated?

A
  • admit
  • IV steroids

—-just to SHORTEN the length of the ACUTE relapse (does not mean pt returns to baseline)

29
Q

How is pyramidal dysfxn treated?

A
  • physiotherapy
  • occupational therapy
  • ANTI-SPASMODIC agent
30
Q

How is spasticity managed?

A
  • physiotherapy
  • oral medication (BACLOFEN/GABAPENTIN)
  • intrathecal BACLOFEN/ PHENOL (bed bound pts)
  • cannabis and botulinum toxin (apparent help)
31
Q

How are sensory symtoms treated?

A 
1- anticonvulsants (GABAPENTIN) 
2- anti-depressant (amitriptyline) 
3- TENS machine 
4- Acupuncture
5- Lignocaine infusion
32
Q

Why are urinary symtpoms presented in MS?

A
  • d.t INcr. tone at bladder neck
  • detruser hypersensitivity
  • detruser sphyncteris dyssenergia (bladder and urethra contracts simultaneously)
33
Q

What is FIRST line for MS disease modifying therapy?

A
  1. Beta Interferon
  2. Glatiramer acetate
  3. Tecfidera
  4. Natalizumab
34
Q

Name interferons?

A

avonex

rebif

35
Q

How effective are interferon?

A
  • decr. relapse rate by 1/3

- severity of relapse decr. by 50%

36
Q

What is first line for relapse-remitting MS?

A
  • TECFIDERA
    (oral agent)
    —-reduces relapse by 44%
37
Q

When to move to second line?

A
  • emergence of new plaques

- foundon mri

38
Q

Name the second line rx for MS.

A
  • Fingolimod/Cadrabine
  • ORAL agents

-monoclonal antibody (Tysabri), ocrevus

39
Q

How effective is the second line?

A

> 50% reduction in relaspe rate

- significant effect in disease progression

40
Q

What is given in those with high disease activity and rapidly evolving severe relapsing remitting MS?

A

single disease modifying therapies

Tysabri

41
Q

Decribe the inflammatory cascade in MS. `

A
  • immune cells pass the BBB
  • these cells re-activate and produce CYTOKINE
  • immune cells MOUNT and autoimmune attack against myelin
42
Q

What is the mode of axn of Tysabri?

A
  • prevents leukocyte migration ACROSS BBb
  • prevents leukocyte priming and activation
  • modulates leukocyte apoptosis

NEUROLOGY (36 decks)

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