Multiple sclerosis

Question 1

what is the definiton of MS?

Answer 1

an inflammatory demyelinating disease charcaterised by the presence of episodic neurological dysfunction in at least 2 areas of the CNS disseminated in time and space

Question 2

what are the classifications of MS?

Answer 2

relapsing-remitting
primary progressive
progressive relapsing remitting
secondary progressive MS (R-R followed by primary progression)

Question 3

how does MS commonly present?

Answer 3

optic neuritis
transverse myelitis
clinically isolated syndrome

sensory features

• paraesthesiae
• decreased vibration sense
• trigeminal neuralgia
• visual phenomena

Motor features

• spastic weakness
• cerbellar signs (ataxia, tremor, speech probs)

sexual
- ED, anorgasmia, incontinence, cognitive decline

Question 4

how is MS diagnosed?

Answer 4

MRI brain/spine with gadolinium contrast
- hyperintensities indicating demyelination

LP
- oligoclonal bands of IgG in CSF

Evoked potentials
- prolonged conduction

Blood tests
- exclude other causes

Question 5

how is MS relapse treated?

Answer 5

IV methylprednisolone

PPI for gastroprotection

prescribe at 9am to avoid sleep disturbances

plasma exchange in severe cases

Question 6

what tests should be done to exclude other causes before MS diagnosis?

Answer 6

• full blood count
• inflammatory markers for example erythrocyte sedimentation rate, C-reactive protein
• liver function tests
• renal function tests
• calcium
• glucose
• thyroid function tests
• vitamin B12
• HIV serology

Question 7

what drugs are used in MS management?

Answer 7

Dimethyl fumarate - oral tab

alemtuzumab - IV a few times a year

Natalizumab - monthy infusions

Fingolimod - oral tablet

Question 8

what are the side effects of dimethyl fumarate?

Answer 8

low WWC and infection risk

Question 9

what are the risk with natalizumab?

Answer 9

progressive multifocal leukoencephalopathy if patient infected with john cunningham virus

Question 10

what are the risks with alemtuzumab?

Answer 10

autoimmune hepatitis

Question 11

what are the risks with fingolimod?

Answer 11

persistent bradycardia

Question 12

how can spasicity be managed in MS?

Answer 12

baclofen or gabapentin

Question 13

how can tremor be managed in MS?

Answer 13

botulinium toxin type A injection

Question 14

how can urinary symptoms be controlled in MS?

Answer 14

self catheterisation

tolterodine (anti muscarinic)

Question 15

how can fatigue be manged in MS?

Answer 15

amantadine
CBT
exercise

Question 16

what are the complications of MS?

Answer 16

UTIs 
Osteoporosis 
depression 
visual impairment 
cognitive impairment