Multiple Sclerosis Flashcards
what is MS
autoimmune degenerative condition causing inflammatory lesions throughout the CNS
outline the pathophysiology of MS
areas of nerves lack myelin sheath as oligodendrocytes are destroyed, inflammation develops causing ‘plaques’
what is pathonomonic of MS
inflammatory plaques must be disseminated in space and time
what are some of the risk factors for MS
genetic predisposition
having EBV in childhood
associated with increased latitude
what are the 4 types of MS
relapsing remitting
secondary progressive
primary progressive
progressive relapsing
describe relapsing remitting MS
most common type
goes through phases of symptoms then they regress to complete recovery
describe secondary progressive MS
symptom progression is slow however patient is always symptomatic
relapsing remitting goes onto develop into this
describe primary progressive MS
10% of cases but most severe form
steady decline with no improvement of symptoms
describe progressive relapsing MS
steady decline from onset of symptoms with super imposed relapses
rarest type
outline the broad clinical features of MS
varies depending on where lesions are present motor sensory transverse myelitis cerebellar ocular features
outline the motor features of MS
pyramidal features increased tone weakness spasticity visible extensor muscles
outline the sensory features of MS
numbness
tingling pain
trigeminal neuralgia
outline the features of transverse myelitis
loss of motor, sensory and autonomic function
loss of bowel and bladder control - urge incontinence
outline the cerebellar features of MS
DANISH dysdiadochokinesia ataxia nystagmus intention tremor staccato speech hypotonia
outline the optic features of MS
optic neuritis
sudden loss of vision
double vision
anterior uveitis
which is a common first presentation
optic neuritis
what is Lhermittes phenomenon
electric shock in arms when head is bent forward
what is Uhtoffs phenomenon
worsening of symptoms with heat and exercise
outline some of the possible examination findings of MS
spasticity, brisk reflexes, +ve Babinski sign
nystagmus, RAPD, internuclear ophthalmoplegia
outline the diagnostic criteria for MS
two episodes of symptoms of MS that last at least an hour and are at least 30 days apart - shows dissemination in space and time
list the investigations and their findings for MS
MRI - shows optic neuritis and plaques of demyelination
lumbar puncture - oligoclonal bands of IgG found on electrophoresis
how is spasticity managed in MS
baclofen
physiotherapy
occupational therapy
how are sensory problems managed in MS
amitriptyline
gabapentin
TENS acupuncture
how is bladder dysfunction managed
bladder training
oxybutynin
how is an acute exacerbation of MS managed
anti-convulsants such as gabapentin/pregabalin
oral or IV methylprednisolone depending on severity
what are the first line DMARDs for MS
B interferon
capaxone
tecfidera
