Multiple sclerosis

Question 1

What is MS

Answer 1

It is a chronic demyelinating disease of the CNS characterised by inflammatory process and causing widespread degeneration of the CNS, gradually resulting in severe neurological deficit. Autoimmune disease

Question 2

MS Facts

Answer 2

around 100,00 people in the UK, 100-120 per 100k, people mainly diagnosed between 20-40, around 3 times as mainly people, no cure for MS, various medicines and therapies to reduce flare ups, more in temperate latitudes than tropics, more prevalent in high socio- economic classes, caucasian>other ethnic groups

Question 3

triggers

Answer 3

infection, vaccination, pregnancy, trauma, emotional stress, environmental factors, viral factors, genetic factors- 1.5% chance of developing it from parents, deficiencies in diet- vitamin D

Question 4

pathology of MS

Answer 4

disruption of blood-brain barrier- no matter what the trigger is, cells that prevent inflammatory cells going into brain
leakage of inflammatory cells- attack brain, destruction of oligodendrocytes and myelin sheath, disruption of nerve signals- rate of conduction is slowed down, plaques can then form throughout the CNS- no conduction

Question 5

MS- meaning

Answer 5

sclerosis means scarring and multiple which relates to the sites of scarring, which can occur in different places throughout the brain and SC

Question 6

what is the aim of MS treatment

Answer 6

reduce destruction, reduce plaque formation, reduce leakage

Question 7

4 types of MS

Answer 7

silent/benign, relapsing-remitting, secondary progressive, primary progressive- most severe

Question 8

signs and symptoms- movements

Answer 8

spasticity and hyperreflexia, ataxia and poor coordination- cerebellum, dizziness and poor balance- vestibular system or cerebellum, fatigue, weakness- motor cortex and descending pathways

Question 9

signs and symptoms- other

Answer 9

visual problems (e.g. visual acuity/ diplopia)- occipital lobe/ optic nerve, thalamus 
sensory loss- tingling/burning- sensory cortex or ascending pathways, sphincter dysfunction and sexual disruption-spinal cord, psychiatric/ psychological disturbances- limbic system/ dopamine system/ hypothalamus, decreased intellectual function- frontal lobe

Question 10

initial symptoms

Answer 10

limbic weakness- 40%, optic neuritis- 22%, paraesthesia- 21%, diplopia- 12%, vertigo-5%, micturition problems- 5%

Question 11

diagnosis

Answer 11

clinical history- diagnosis of exclusion, nerve conduction tests- e.g. auditory evoked potentials, MRI scan, lumbar puncture test- CSF

Question 12

what is an MS relapse

Answer 12

clinical event lasting at least 24 hours associated with MS
a single paroxysmal episode (Tonic spasm) does not constitute a relapse, but multiple paroxysmal events occurring over 24 hours or more can equal an attack
need to treat quickly- can lead to permanent changes in CNS

Question 13

MS relapse

Answer 13

objective findings must be present e.g. symptoms alone, no matter how characteristics, do not count
the event is not temporary worsening entirely due to a fever or infection, to count as a distinct (new)attack, the onset of clinical event must be at least 30 days after the onset of any prior attach

Question 14

how to treat MS relapse

Answer 14

IC Methyl prednisole- steroid, oral method prednisolone 500mg/day for 10/7 with ranitidine for 10/7, do not give low prolonged steroid treatment, plasmapheresis

Question 15

medical treatment of symptoms

Answer 15

anti-spasticity agents/ relaxants- baclofen, tizanidine

neuropathic pain, antidepressants, analgesia, bladder problems- anticholinergic drugs, diet, hyperbaric oxygen

Question 16

problems with baclofen and tizanidine

Answer 16

act central can wipe out things completely- leads to tiredness

Question 17

prognosis

Answer 17

highly variable/ difficult to predict, earlier age at diagnosis favours slower onset of progression- more rapid after age 40, only 50% still walking unaided 15 years after diagnosis, health related quality of life on average 30% lower, suicide risk 7.5 times greater, wide variation on impact on lifespan, disease modifying treatment

Question 18

common causes of death associated with MS

Answer 18

chronic bed sores, urogenital sepsis and aspiration or bacterial pneumonia

Question 19

outcome measures

Answer 19

stage and severity of disease- expanded disability status scale, function/participation- impact of MS in daily life- MSIS-29, activities- impact of MS on walking- MSWS-12, impairments/activities- balance- functional tests