Multiple Sclerosis Flashcards
Describe what multiple sclerosis is?
Most common neuroinflammatory disorder in western populations. A chronic auto-immune T cell mediated inflammatory disorder of the CNS. Multiple plaques of demyelination are found throughout the brain and spinal cord occurring sporadically over years.
MS is more common in women or men?
women
What age do people typically present with MS?
between 20-40yrs
Describe genetics of MS?
not fully understood however you can have a genetic predisposition to developing the condition, if someone in your family has it you are more likely to get it
What are the cardinal pathological features of MS?
plaques of demyelination 2-10mm in size
List some common places MS plaques are found?
optic nerves, periventricular region, the corpus callosum, the brainstem, cerebellar connections and the cervical spinal cords
Are peripheral myelinated nerves affected in MS?
NO not directly, as the condition affects the CNS
Describe the pathology of acute relapses in MS?
These are caused by focal inflammation causing myelin damage and conduction block, recovery follows as inflammation subsides and remyelination occurs. When damage is severe, secondary permanent axonal destruction occurs.
What is the pathological basis of progressive disability in progressive MS?
progressive axonal damage
Describe some symptoms of pyramidal dysfunction that may occur in MS?
increased tone
spasticity
weakness
extensors of upper limbs are weak and flexors of lower limbs are weak
Describe optic neuritis and how someone might present with MS?
painful visual loss in an eye developing over 1-2 weeks
pain on eye movements
very rarely complete blindness usually loss of central vision with colour desaturation
RAPD
most improve with time
Describe sensory symptoms someone with MS might experience?
unusual sensations
reduced vibration and proprioception
pain
paraesthesia
Describe symptoms of cerebellar dysfunction that may be experienced in MS?
dysarthria (poor articulation, difficulty speaking)
ataxia (broad based gait, unstable, veers to side)
nystagmus (involuntary eye movements)
intention tremor (as the cerebellum controls movements guided by eyes)
dysdiadochokinesia (impaired ability to perform fast alternating movements e.g. clumsy alternating supination pronation of the hands)
Describe symptoms that may appear if MS was affecting the brain stem?
6th cranial nerve palsy (diplopia)
7th cranial nerve palsy (facial weakness)
Describe symptoms that may appear if MS was affected the lower urinary tract?
bladder hyper-reflexia causing urinary urgency and frequency
What is a common symptom many people with MS complain of?
fatigue
Describe the requirements for diagnosis of MS?
at least 2 episodes suggesting demyelination
evidence of damage to the CNS that is disseminated in time and space ie damage occurred on different dates and different places
Describe investigations done to rule in or out MS?
blood tests done to exclude other inflammatory disorders and infections e.g. borrelia, syphylis
MRI is the definitive investigation as it demonstrates areas of demyelination with high sensitivity
Lumbar puncture is abnormal in most patients with MS, get oligoclonal bands in the CSF with no corresponding bands in the serum
Describe lumbar puncture results in MS?
Lumbar puncture is abnormal in most patients with MS, get oligoclonal bands in the CSF with no corresponding bands in the serum
Name the 4 types of MS?
relapsing remitting
secondary progressive
primary progressive
relapsing progressive
What is the most common type of MS?
relapsing remitting MS
Describe relapsing remitting MS?
most common, symptoms in attacks which get better fully or partially over weeks, may accumulate disability over time if don’t fully recover after relapses
Describe secondary progressive MS?
late stage MS, 75% of RRMS evolve into this within 35yrs of onset where there is gradually worsening disability
Describe primary progressive MS?
gradually worsening disability without relapses or remissions
Describe relapsing progressive MS?
least common, relapses on pattern of progressive disability from the outset
Describe treatment of an acute exacerbation of MS?
mild - observation and or symptomatic treatment
moderate- oral steroids over 5 days (methylprednisolone)
severe - admit for IV steroids
Describe symptomatic management of pyramidal dysfunction?
physio, OT, oral antispasmodic agents e.g. baclofen
Describe symptomatic management of sensory dysfunction?
gabapentin, amitriptyline if resistant lignocaine
Describe symptomatic management of urinary tract issues?
most patients just receive bladder training advice
anti-cholinergics e.g. oxybutynin sometimes given to reduce detrusor excitability
Describe symptomatic treatment of fatigue?
fatigue diaries with the OT, amantadine works for some, modafinil if sleepy, hyperbaric oxygen
Describe disease modifying therapy for MS?
First line (for those with RRMS)- tecfidera (oral) interferons and glitiramer acetate (injection) all shown to reduce relapse rate Second line (for those 1st line not worked or v aggressive on initial presentation) - fingolimod, cladribine, monoclonal antibodies, actually more effective at reducing relapses but these drugs are very toxic
