Multiple Sclerosis

Question 1

Define MS

Answer 1

disease of CNS (brain and spinal cord)

periods of increasing and decreasing signs and sx (exacerbation and remission) d/t loss of myelin at multiple sites

Question 2

What are neuro sx seen in MS

Answer 2

paresthesia (tingling)

gait disturbance

weakness

visual loss (ex: optic neuritis)

urinary difficulty

dysarthria

hemiparesis

Question 3

What are the 4 types of MS

Answer 3

1) Relapsing remitting (50%)
2) Secondary progressive (20%) –> basically after dx with relapsing remitting when it’s a steady decline, not waxing and waning anymore
3) Primary progressive (20%) –> gradually gets worse over time instead of wax and wane
4) Benign (10%)

Question 4

Is MS a disorder of the CNS?

Answer 4

yes- brain and spinal cord

Question 5

When are most MS patients diagnosed?

Answer 5

20s and 30s

average 29, 15-50

Question 6

Can a single test confirm the diagnosis of MS?

Answer 6

no, need multiple studies

Question 7

What is the believed to be the cause of MS?

Answer 7

Some genetic susceptibility

childhood event or illness sensitizes immune system to attack CNS myelin–> adult event triggers it

Question 8

Does MS affect men or women more? Which is more favorable?

Answer 8

W>M

W more favorable

Question 9

Earlier onset of MS is…

Answer 9

more favorable prognostic feature

Question 10

Describe geographic distribution of MS and when it matters

Answer 10

matters before age 14

temperate zones have higher incidence have tropical zones

Question 11

What studies are used to diagnose MS?

Answer 11

MRI of head, C and T spine
–>see oval lesions with high signal on T2 in periventricular white matter and spinal cord (acute lesions can enhance)

Multimodality evoked potentials

Lumbar puncture for CSF
–> oligoclonal bands, increased IgG index

Question 12

How is MS diagnosed?

Answer 12

multiple lesion OVER space and TIME

Question 13

How are drugs used and what types in MS?

Answer 13

maintenance of MS–> decrease frequency and severity, slow progression

IFN-B inhibitors, immune suppressants (zumab)

Question 14

What forms of MS do drugs help with?

Answer 14

relapsing remitting

NOT primary progressive except Ocrevus

Question 15

What is the only drug available to treat primary progressive MS?

Answer 15

Ocrevus (ocrelizumab)

Question 16

What meds to treat an acute exacerbation of MS?

Answer 16

high dose corticosteroid (reduce length but not overall outcome)

ACTH gel–>expensive as hell

Question 17

What is are ddx for MS?

Answer 17

Clinically Isolated Syndrome (CIS)

autoimmune
neuromyelitis optica
B12 deficiency
lymphoma/leukemia with CNS
etc

Question 18

What is a monofocal episode of CIS?

Answer 18

single neuro sign or symptom that is caused by a SINGLE lesion
–>optic neuritis in one eye

Question 19

What is a multifocal episode of CIS?

Answer 19

AKA Acute Disseminated Encephalomyelitis

1+ sign or sx caused by 1+ lesions in more than one place AT ONE TIME

–>optic neuritis in one eye plus hemiparesis

Question 20

Are CIS patients at risk for developing MS?

Answer 20

HIGH risk if have multiple demyelinating lesions on MRI (60-80% within several years)

LOW risk if no multiple demyelinating lesions (20%)

Question 21

Describe Neuromyelitis Optica/ Delvic’s Disease

Answer 21

variant of MS?

inflammation and demyel of optic nerves and spinal cord

SPARES BRAIN

NMO Ab in blood and CSF

steroids, plasma exchange, immunosuppression

Question 22

Sx of MS

Answer 22

Spasticity
Initiation Tremor
Urinary Urgency/Retention/Hesitancy
Painful dysesthesias
Fatigue (debilitating)