Multiple Sclerosis Flashcards
What is the pathophysiology of MS?
Inflammatory demyelinating disorder of CENTRAL nervous system
Plaques disseminated in place and time
What are the risk factors for MS?
Female (age 30-40 onset)
Link to vitamin D deficiency
Give some examples of clinical presentations of MS
Unilateral optic neuritis (pain on eye movement and reduced central vision) Numbness or tingling in limbs Leg weakness Diplopia Ataxia Trigeminal neuralgia Erectile dysfunction Urinary symptoms ... many more
How is a diagnosis of MS made?
At least 2 episodes suggestive of demyelination, separated in time AND place
MRI to visualise lesions
Lumbar puncture
What CSF finding would be suggestive of MS?
Oligoclonal bands of IgG that are not present in serum
–> suggests CNS inflammation
What are the main principles of management in MS?
Acute exacerbation
Symptomatic treatment
Disease modifying therapy
Stress reduction (stress increases development of new lesions)
Vitamin D if poor diet or reduced sunlight exposure
How do you treat an acute exacerbation of MS?
Mild –> symptomatic treatment
Moderate –> oral steroids
Severe –> Admit + IV steroids
Which steroid is used for acute exacerbations of MS?
Methylprednisolone
What are the treatment options for weakness and spasticity?
Physiotherapy
Baclofen or tizanidine to relax muscles
Botox
Intrathecal (into spinal canal) baclofen or phenol
What are the treatment options for sensory symptoms such as pain, paraesthesia, trigeminal neuralgia?
Gabapentin
Amitriptylline
TENS machine
Acupuncture
What are the treatment options for urinary dysfunction?
Bladder drill
Anti-cholinergics e.g. ocybutynin
Desmopressin
Catheterisation
How can fatigue be treated?
Amantadine
Modafinil if sleepy
Hyperbaric oxygen
What are the first line disease modifying therapies?
Interferons
Glitiramer acetate
Tecfidera
Which disease modifying agent is first line in relapsing remitting MS?
Tecfidera
What are the second line disease modifying therapies?
Monoclonal antibodies e.g. Tysabri
Fingolimod
