Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

• chronic cell-mediated autoimmune disorder
• demyelination in CNS
• more women
• 20-40yo
• higher latitudes

Question 2

Multiple sclerosis subtypes:

Answer 2

• relapsing remitting disease
• secondary progressive disease
• primary progressive disease

Question 3

Relapsing remitting multiple sclerosis:

Answer 3

• most common - 85%

- acute attacks last 1-2 months followed by periods of remission

Question 4

Secondary progressive disease multiple sclerosis:

Answer 4

• relapsing remitting patients who have deteriorated and developed neuro signs and symptoms between relapses
• 65% relapsing remitting patients progress
• gait and bladder disorders

Question 5

Primary progressive multiple sclerosis:

Answer 5

• 10%
• progressive deterioration from onset
• more common in older

Question 6

MS symptoms:

Answer 6

• non specific e.g. significant lethargy
• visual
• sensory
• motor
• cerebellar
• other: urinary incontinence, sexual dysfunction, intellectual deterioration

Question 7

MS visual symptoms:

Answer 7

• optic neuritis: most common presenting feature
• optic atrophy
• Uhtoff’s phenomenon
• internuclear ophthalmoplegia

Question 8

MS sensory symptoms:

Answer 8

• pins/needles
• numbness
• trigeminal neuralgia
• Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion

Question 9

MS motor symptoms:

Answer 9

spastic weakness: most common in legs

Question 10

MS cerebellar symptoms:

Answer 10

• ataxia (more in acute relapse)

- tremor

Question 11

Investigations of MS:

Answer 11

MRI:
-high signal T2 lesions
-periventricular plaques
-Dawson fingers - hyperintense lesions perpendicular to corpus callosum
CSF
-oligoclonal bands (not in serum)
-increased intrathecal synthesis of IgG
Visual evoked potentials
-delayed but well preserved waveform

Question 12

Treatment of acute MS relapse:

Answer 12

• high dose steroids (e.g. oral or IV methylprednisolone)
• 5 days to shorten length of acute relapse
• does not alter degree of recovery

Question 13

Disease modifying drugs used in MS:

Answer 13

• beta interferon to reduce relapses with certain criteria
• glatiramer acetate - immunomodulating drug
• natalizumab - recombinant monoclonal Ab which antagonises alpha-4 beta-1 integrin on leucocytes so no migration across BBB
• fingolimod: sphingosine 1-phosphate receptor modulator prevents lymphocytes leaving lymph nodes

Question 14

Drugs used for spasticity in MS:

Answer 14

• baclofen and gabapentin
• other: diazepam, dantrolene and tizanidine
• physiotherapy

Question 15

Drugs used for bladder dysfunction in MS:

Answer 15

• intermittent self-catheterisation if significant residual volume
• anticholinergics may improve urinary frequency

Question 16

Drug for oscillopsia in MS:

Answer 16

gabapentin