Multiple Sclerosis

Question 1

Demyelination in PNS or CNS?

Answer 1

CNS

Question 2

General pathophysiology of MS

Answer 2

Areas of demyelination = plaques
Plaques can either be active or inactive
Common area of demyelination = corpus callosum, optic nerve, periventricular white matter and cerebellar white matter

Question 3

RF of MS

Answer 3

Higher latitude (north + south poles) 
Previosu EBV infection 
1st degree relative with MS 
Presence of HLA DRB1 
Common in young females

Question 4

Clinical features of MS

Answer 4

Pyrimidal dysfunction:
UMN dysfunction (extensors of upper limb and flexors of lower limb) 
Tonic spasms 

Occular symptoms:
Optic neuritis - painful eye movements and visual loss, colour destauration, RAPD
Horizontal dipolpia - R eye unable to adduct. L eye has nystagmus when attempting a horizontal gaze

Sensory symptoms:
Water trickling down neck
Clumsiness (loss of proprioception on DCML tract)
Numbness
Trigeminal neuralgia
L’hermitte sign - electric shock in upper limbs
Uhthoff’s phenomenon - exacerbation of temp sensation

Other symptoms:
Cerebellar dxysfunction - DANISH
Fatigue
Lower urinary symptoms

Question 5

Ix of MS

Answer 5

MRI imaging - demonstarte white matter plaques

CSF analysis - IgG oligoclonal bands

Question 6

Mx of ACUTE MS

Answer 6

Mild - symptomatic treatment
Moderate - Oral prednisalone
Severe - hosp admission and IV methlyprednisalone

Question 7

Mx of Disease modifying therapy

Answer 7

Tecfidera, Beta Interferon or Glatiramer acetate

If these do not work:

• Natalizumab - monocloncal antibody
• Fingolimod
• Ocrelizumab (1st line in early primary progressive MS)

Question 8

What to give in symptomatic management of spasticity?

Answer 8

Physiotherapy and Oral baclofen/gabapentin

Question 9

Symptomatic management of sensory symptoms

Answer 9

Gabapentin for neuropathic pain

Question 10

Symptomatic management of fatigue

Answer 10

Amantadine +/- modafinil if excessive daytime sleepiness

Question 11

Symtpomatic management of bladder dysfunction

Answer 11

Bladder physiothepray
catheterisation
Anticholinergic drugs (oxybutynin) if urge incontinence