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09. Year 2: Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Do younger or older people normally get MS?

A

Younger

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2
Q

Is the presentation of MS consistent or variable?

A

Variable

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3
Q

What is MS a disease of?

A

The central nervous system, causing demyelination and inflammation which leads to focal disturbance of function

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4
Q

What is the prevalence of MS?

A

190/100,000 in Scotland

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5
Q

What does MS stand for?

A

Multiple sclerosis

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6
Q

When is the most common age of onset for MS?

A

About late 20s/30

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7
Q

What is the initial presentation of MS?

A

Relapse (demyelination and inflammation)

Gradual onset over days

Stabilises days to week

Gradual resolution

Partial or complete recovery

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8
Q

What is seen during a relapse phase of MS?

A

Optic neuritis

Sensory symptoms

Limb weakness

Brainstem problems (cranial nerve involvement, pons-internuclear ophthalmoplegia, diplopia, vertigo/ataxia, upper motor neurons signs)

Spinal cord problems (bilateral motor and sensory symptoms, bladder involvement)

Myelitis

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9
Q

What is optic neuritis?

A

Subacute visual loss

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10
Q

What are clinical signs of optic neuritis?

A

Pain on moving eye

Colour vision disturbed

Initial swelling optic disc

Optic atrophy seen later

Relative afferent pupillary defect

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11
Q

What is pons-internuclear ophthalmoplegia?

A

Disorder of horizontal occular movement due to a lesion on the brainstem

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12
Q

What is diplopia?

A

Double vision

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13
Q

What is myelitis?

A

Inflammation of the spinal cord

Can be partial or transverse (complete)

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14
Q

What are the 2 different kinds of myelitis?

A

Partial or transverse (complete)

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15
Q

What is the clinical presentation of myelitis?

A

Weakness/upper motor neuron changes below level of demyelination

Bladder and bowel involvement

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16
Q

What is responsible for demyelination in MS?

A

Autoimmune process

Activated T cells cross blood brain barrier causing demyelination

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17
Q

What can demyelination in MS be seen by?

A

Lesions or plaques on MRI scan

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18
Q

What is the process of demyelination in MS?

A

1) Acute inflammation of myelin sheath
2) Loss of function
3) Repair
4) Recovery of function
5) Post inflammatory gliosis
6) May have funcitonal defect

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19
Q

What is gliosis?

A

Non-specific change of glial cells in response to damage to CNS

Usually hypertrophy (growth) or proliferation (increase in numbers) of glial cells

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20
Q

What are the different disease courses of MS?

A

Clinical isolated syndrome

Relapsing-remitting MS

Primary progressive MS

Secondary progressive MS

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21
Q

What is clinical isolated syndrome MS?

A

Refers to first episode of neurologic symptoms that last at least 24 hours

Sometimes no further episodes

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22
Q

What are further relapses of MS usually due to?

A

Underlying infection (25-30%)

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23
Q

What is important for the progression of MS?

A

Axonal loss is important for disease progression and development of persistent disability

24
Q

What are examples of symptoms that can accumulate during the progressive phase?

A

Fatigue

Temperature sensitivity

Sensory symptoms

Stiffness or spasms

Balance problems

Slurred soeech

Bladder and bowel

Diplopia/oscillopsia/visual loss

Swallowing

Cognitive dementia/emotional liability

25
What is oscillopsia?
Images are no longer held steady on the retina (vision loss)
26
What do the signs observed in examination due to MS depend on?
Where the demyelination has occured and the stage of disease
27
What are some things seen in examination of MS?
Afferent pupillary defect Nystagmus or abnormal eye movements Cerebellar signs Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor
28
What does RRMS stand for?
Relapsing remitting MS
29
What does SPMS stand for?
Secondary progressive MS
30
What does PPSM stand for?
Primary progressive MS
31
What is the most common type of MS?
Relapsing remitting MS (RRMS) 85% at outset
32
What is the different between the impairment level of primary and secondary progressive MS?
33
When does primary progressive MS usually present?
In 5th and 6th decade
34
In what kind of MS do no relapses occur?
Primary progressive
35
What are symptoms of primary progressive MS?
Spinal and bladder symptoms
36
What is the male to female ratio of primary progressive MS?
1:1
37
What is required to make the diagnosis of MS?
Evidence of demyelination seperate in time and space May be clinical or MRI based diagnosis
38
What are the clinical and MRI based diagnostic criteria called?
Posers criteria (clinical) Macdonald criteria (MRI)
39
What chemical can be used with an MRI scan to better show new lesions?
With gadolinium new lesions are shown as they uptake it whereas old ones do not
40
What are some conditions including in the differential diagnosis for MS?
Acute desseminated encephalomyelitis (ADEM) Other autoimmune conditions such as SLE Sarcoidosis Vasculitis Infection such as lyme disease Adrenoleukodystrophy
41
What does ADEM stand for?
Acute disseminated encephalomyelitis
42
What is optic neuritis?
Inflammation of the optic nerve
43
What are some differentials for optic neuritis?
Neurolyelitis optica Sarcoidosis Ischaemic optic neuropathy Toxic/drugs/B12 deficiency Wegeners granulomatosis Local compression Lebers hereditary optic neuropathy Infection (TB or HIV)
44
What are differentials for myelitis?
Inflammation (neuromyelitis optica, SLE, sarcoidosis) Infection or post infection (HIV, HTLV, HSV, TB) Tumour Paraneoplasic process Stroke
45
Other than MRI, what other investigations can be done for MS?
Lumbar puncture (oligoclonal bands present in CSF but not serum) Visual/somatosenosory evoked response Bloods to exclude other inflammatory conditions Chest x-ray
46
MS never affects the activities of daily living (ADL) for how many people with it?
25%
47
What percentage of people with MS require a wheel chair at some point?
25%
48
What is the female to male ratio for MS?
2-3:1
49
What is the general treatment of MS?
Treatment of relapse Disease modifying treatment General health and diet Symptomatic treatment MDT approach
50
What is the treatment for an acute relapse of MS?
Look for underlying infection Exclude worsening of usual symptoms with intercurrent illness Treatment (oral prednisolone (IV), rehabilitation, symptomatic treatment)
51
What are some 1st line disease modifying treatments for MS?
S/C or I/M injections (beta-interferons, glatiramer acetate)
52
What are some 2nd line disease modifying treatments for MS?
Natalizumab Fingolimod Cladribine Ocrelizumab Alemtuzumub
53
What is the function of disease modifying treatments for MS?
They are not a cure, they reduce relapse rate, do not slow down progression and have side effects
54
Who can disease modifying treatments for MS give problems to?
People who are immunosupressed and can lead to multifocal leukoencephalopathy
55
What are some sympatomatic treatments for MS?
* Spasticity-muscle relaxants/antispasmodics/physiotherapy * Dysaesthesia * Amitriptyline, gabapentin etc * Urinary anticholinergic Rx, bladder stimulator/catheterisation * Constipation * Laxatives * Sexual dysfunction * Sildenafil * Fatigue * Graded exercise, medication * Depression * CBT, medication * Cognitive * Memory aids * Tremor * Aids/medication * Vision * Carbamazepine * Speech/swallowing * SALT * Motor/sensory impairment * MDT
56
Who are some members of the MDT than looks after people with MS?
MS nurse Physiotherapist Occupational therapist Soeech and language therapy Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry

09. Year 2: Nervous System (48 decks)

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