Multiple sclerosis Flashcards
Cause of MS
Inflammatory demyelinating disorder of the CNS- discrete plaques of demyelination occur at diff CNS sites- T cell mediated immune response.
Effect of prolonged demyelination
axonal loss and clinically progressive symptoms
What can potentially prevent MS
Vit D
Presentation
Usually mono symptomatic
Pyramidal dysfunction- increased tone, spasticity, weakness (extensors upper limb, flexors lower limb)
optic neuritis (pain on eye movement and decreased central vision)
sensory dysfunction
lr urinary tract dysfunction
cerebellar and brain stem features
cognitive impairment
Diagnosis
At least 2 episodes suggestive of demyelination
McDonald criteria
Lesions disseminated in time and space and unattributable to other causes
MRI
CSF- oligoclonal bands of IgG on electrophoresis that are not present in serum. Unmatched.
Progression
most follow relapsing remitting course, secondary progressive (time between relapses shorter until remission incomplete), primary progressive, progressive relapsing
Management of acute exacerbation
Mild- symptomatic tx
Mod- oral steroids
Severe- IV steroids
Disease modifying therapy
1st line- and capstone telfidira 2nd line- fingolimod monoclonal antibodies- alemtuzumab, natalizumab 3rd line- mitoxantrone
What is associated with all second line therapies
progressive multifocal leucoencephalopathy
JC virus positive
Symptomatic tx
Pyramidal dysfunction- physio, OT, anti spasmodic
Spasticity- physio, baclofen
Sensory symptoms- gabapentin, amytryptiline, tens machine, acupunctute, lignocaine infusion
Tremor- botulinum toxin type a injection
Devics syndrome
neuromyelitis optica- transverse myelitis, optic atrophy, anti- aquaporin antibodies
Lhermittes sign
neck flexion causes electric shocks in limbs
Uthoff’s phenomenon
worsening symptoms in bath
Charles bonnet syndrome
decreased acuity + complex visual hallucinations
pulfrich effect
unequal eye latancies- straight lines look curved
