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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the epidemiology of multiple sclerosis?

A

12% risk if both parents affected
Risk increases as distance from equator increases
More common in women = presents usually in 30s

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2
Q

What is multiple sclerosis?

A

Inflammatory demyelinating disorder = myelin sheath is first area affected, plaques disseminated in time and place

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3
Q

What are the different types of multiple sclerosis?

A

Relapsing and remitting multiple sclerosis
Secondary progressive multiple sclerosis
Progressive relapsing multiple sclerosis
Primary progressive multiple sclerosis

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4
Q

What are some features of relapsing remitting MS?

A

Optic or sensory symptoms = flares up then goes away, most common type

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5
Q

What are some features of secondary progressive MS?

A

Develops from relapsing remitting MS = symptoms get progressively worse

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6
Q

What are some features of progressive relapsing MS?

A

Rarest type = progression occurs quickly from symptom onset

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7
Q

What are some features of primary progressive MS?

A

Occurs in about 10% of patients = never experience any kind of relapse

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8
Q

What are some symptoms of multiple sclerosis?

A

Pyramidal dysfunction and sensory symptoms
Optic neuritis and lower UT dysfunction
Cerebellar and brainstem features
Cognitive impairment

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9
Q

What are some features of pyramidal dysfunction?

A

Weakness, increased tone, spasticity

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10
Q

What areas of the body are commonly affected by weakness in multiple sclerosis?

A

Extensors of arms and flexors of legs

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11
Q

What are some features of optic neuritis?

A

Painful vision loss = occurs over 1-2 weeks, most improve with time, RAPD

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12
Q

What are some symptoms of cerebellar dysfunction?

A

Dysarthia, ataxia, nystagmus, intention tremor

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13
Q

What is internuclear ophthalmoplegia?

A

Disturbance of binocular vision due to defect in medial longitudinal fasciculus = failure of abduction, diplopia, nystagmus in abducting eye, lag

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14
Q

How is fatigue treated?

A

Amantidine, modafinil if sleepy, hypertonic oxygen

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15
Q

What is the diagnostic criteria for multiple sclerosis?

A

At least two episodes suggestive of demyelination = dissemination in time and place, alternative diagnosis excluded

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16
Q

What investigations can be done for multiple sclerosis?

A

MRI, CSF, neurophysiology, blood tests

17
Q

What are the differentials of multiple sclerosis?

A

Vasculitis, granulomatous disorder, vascular disease, structural lesion, infection, metabolic disorder

18
Q

What blood tests are done for multiple sclerosis?

A

Done to exclude differentials = PV, FBC, CRP, renal/liver/bone profile, auto-antibody screen, borelia/HIV/syphilis serology, B12, folate, vitamin D

19
Q

How good is a lumbar puncture in detecting multiple sclerosis?

A

Abnormal in 90+% of patients = oligoclonal bands in CSF but not in serum

20
Q

What is the management of acute multiple sclerosis?

A 
Mild = symptomatic treatment, may do nothing
Moderate = methylprednisolone for 5 days
Severe = IV steroids
21
Q

How is pyramidal dysfunction treated?

A

Anti-spasmodics and physio

22
Q

How is spasticity treated?

A

Baclofen or tizanidine, physio

23
Q

What are some agents used for symptomatic management in multiple sclerosis?

A

Anti-convulsants, tricyclics, tens machine, acupuncture, lignocaine if severe pain

24
Q

What are the first line agents for disease modifying therapy in multiple sclerosis?

A

For relapsing remitting MS with moderate symptoms = tecfedira/aubagio, interferon beta, glitiramer acetate

25
Q

What are the second line agents for disease modifying therapy in multiple sclerosis?

A

For patients who haven’t improved on first line or have severe symptoms = tysabri/ocrevus/lemtrada (monoclonal antibodies), fingolimod, cladrabine

26
Q

What are the third line agents for disease modifying therapy in multiple sclerosis?

A

Mitoxantrone, HSCT (stem cell transplant)

27
Q

What are some features of tecfedira?

A

Oral 1st line agent = 44% reduction in relapse rate

28
Q

What are some features of interferon and glitiramer acetate?

A

Injectable = decrease relapse by 1/3 and severity of relapse by 50%

29
Q

What are some features of fingolimod/cadrabine?

A

Oral 2nd line agents = >50% reduction in relapse rate

Toxic = need to wear cardiac monitor for a day before prescribing and lowers WCC

30
Q

What are some examples of monoclonal antibodies?

A

Anti CD20 = ocrelizumab, rituximab
Anti CD50 = alemtuzemab
Anti-integrin = natilizumab

31
Q

When are monoclonal antibodies indicated for treating multiple sclerosis?

A

Highly active relapsing remitting multiple sclerosis

Neurology (48 decks)

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