Multiple Sclerosis Flashcards
Define Multiple Sclerosis
Inflamatory autoimmune disease characterised by demylination of CNS neutons
Typically defined as 2 neurological events separated by space (location) and time
Aetiology and risk factors of Multiple Sclerosis
Pathogenesis is unknown, but it affects mostly CNS white matter. Degenerative demyelination and inflammatory. Possibly triggered by environment
common phenotypes are Relapsing-remitting disease (episodes, breaks, episodes) and Progressive disease
Risk factors:
20-40 years old
Female
Northern Hemisphere
Family history
Smoking
Vit D deficiency
Other Autoimmune disease
EBV
Signs and symptoms of Multiple sclerosis
Middle age females
Can be many forms of neurological-diagnostic is usually 2 events separated In time and location
common: Visual disturbance in one eye (praying/blurring vision)
Sensory changes: report feeling wetness/hotness in areas, or hemibody tingles
Especially banding of
Less common:
Foot dragging/slapping: after walking a while, weak foot (resolves with rest)
Leg jerk/cramps-involuntary movement at rest
Fatigue
Urinary retention and UTI
Bowel dysfunction
UMN signs (high muscle tone and hypereflexia-unilateral)
Imbalance
slowly progesses-more common attacks, more severe
lose more motor functions
Investigations for Multiple Sclerosis
BRAIN MRI-abnormal-using FLAIR MRI-white patches around corpus calosum and around ventricles
Spinal Cord MRI-Demyelination of cord (especially cervical cord)
Bloods, TSH, B12 should be normal
Conduction studies
LP-high IgG
management of acute MS
if affecting day to day —Methyprednisolone high dose IV or oral taper
can consider plasma exchange if contraindicated because of diabetes, other
Find if any cause for relapse- like infections
Management of chronic MS
Several medication now for relapsing MS- and reduce the rate of attacks
1st line
interferon B preps (slow progress, but flu like sx after intake)
Galatiramer- slow progress, but takes a while to work (9m)
dymethyl fumarate , diroximel fumarate (ORAL therapy!- reduce attacks
teriflunomide -reduce attacks
always physio, SALT, OT
supportive-
urinary incontinence-oxybutnin, physio
Neuropain- gabapentin
Muscle spasm- baclofen
care of reccuring UTIs
and osteopenia- always give Vit D if housebound
Complications/long term of MS
Reccurent UTI
but also osteopenia/porosis/malacia
commonly visual impairments that worsen
slow cognitive impairment
slow loss of mobility
but very variable, and some conserve function for years
others lose it very fast
