Multiple sclerosis

Question 1

What is MS?

Answer 1

neurodegenerative autoimmune condition that attacks the CNS (myelin sheaths on the axons), combination of genetic and environmental factors. Characterised by multiple episodes of neurological symptoms then remission

Question 2

How many people roughly have MS?

Answer 2

60,000

Question 3

What are the symptoms of MS

Answer 3

Weakness
numbness
loss of senses
loss of balance, slips and trips

Question 4

What are Uhtoffs and Lhermitts phenomena?

Answer 4

Uhtoffs - symptoms worse on increased body temp

Lhermittes - electrical sensation running down the spine

Question 5

What type of disease is MS?

Answer 5

Relapsing and remitting (initially get relapse as CNS repairs itself but most go on to be chronic progressive)

Question 6

What are the 3 pathological hallmarks of MS

Answer 6

1. inflammation of brain and spinal cord leading to acute loss of function and immune cells which attack cells involved in myelination (plaques)
2. Demyelination loss of myelin sheaths so nerves cannot transmit APs
3. Neurodegeneration due to the accumulation of demyelination and inflammation which leads to axonal loss and neuronal death.

Question 7

What are the causes of MS

Answer 7

Genetics e.g. family is a major part

Environment e.g. infection, epstein barr virus, low sunlight/vitamin D

Question 8

What is treatment of an acute relapse of MS?

Answer 8

Oral methylprednisolone 500mg/day for 3-5 days to reduce immune response and inflammation (high dose) (or IV)

Question 9

What are some treatments in MS

Answer 9

Natalizumab 
Fingolimod
dimethyl fumarate (tecfidera)
Alemtuzumab 
Teriflunomide CCS immunomodulator

Question 10

How common is bladder /bowel problems in MS patients and how can this be treated?

Answer 10

70-80% of patients

Treated via sativex, alfuzocin, trospium

Question 11

what % of MS patients have pain?

Answer 11

80%

Question 12

What can be used to treat spascity? 1st line and 2nd line

Answer 12

Baclofen
Gabapentin

2nd line: sativex (cannabinoid) tizanidine, diazepam, Intrathecal baclofen

Question 13

What is a drug that MS patients commonly use to self medicate with? how does this help? What are the legal aspects of this use?

Answer 13

Cannabis - tremor, spasticity, pain, bladder

It is illegal in the UK under the misuse of drugs act 1971/2001 and not recommended by NICE.
CBD oil can be bought OTC

Question 14

What mab is now available on the NHS for MS? What is its MoA?

Answer 14

Alemtuzumab - it is an anti-CD52 antibody that reduces inflammatory response in early MS

Question 15

Why is the prevalence much higher than the incidence?

Answer 15

Because people can live with MS for many years. Not many new cases per year but many people living with it

Question 16

What are the positive phenomena caused by (uhtoffs and Lhermittes)

Answer 16

Hyperexcitability due to demyelination

Question 17

What is fingolimod (Gileyna) and what is the criteria that a patient should meet to receive it?

Answer 17

Sphingosine analogue.
Criteria: must have an unchanged or increased rate of ongoing severe relapses compared to previous year despite treatment with beta interferon, AND the manufacturer provides it with discount as part of the patient access scheme

Question 18

If a patient has. cognitive. symptoms - would. you use medication?

Answer 18

Yes if there is a decline in function as majority of MS patients have some sort of cognitive decline e.g. Donepazil, but they haven’t gone through Clinical trials in MS patients so it is not recommended by NICE- not recommended for this indication - off label use

Question 19

What are future treatment considerations for MS?

Answer 19

Stem cell therapy but expensive and unlikely to be on NHS