Multiple Sclerosis Flashcards
what is MS?
demyelination of the CNS with attacks caused by inflammatory plaques affecting nerve transmission
causes of MS
genetics
environment e.g. EBV, latitude
demographic of MS
females
20-40
classification
begins as CIS which can develop into:
- relapsing and remitting
- secondary progressive
- primary progressive
describe the course of relapsing and remitting
neurological symptom followed by complete/partial recovery
describe the course of secondary progressive
progressive worsening of neurological function overtime with incomplete remissions
describe the course of primary progressive
worsening neurological function without relapses or remissions
presentation
- Pyramidal dysfunction e.g. weakness, spasticity, upper limb extensors and lower limb flexors
- Optic neuritis e.g. painful visual loss, most improve, RAPD
- CNVI palsy= internuclear ophthalmoplegia and conjugate lateral gaze disorder
- Sensory symptoms e.g. pain, paraesthesia, dorsal column loss (proprioception and vibration), numbness and trigeminal neuralgia
- Lower urinary tract e.g. incontinence, frequency, nocturia, urgency, urge, retention
- Cerebellar and brainstem features e.g. dysarthria, ataxia, nystagmus, tremor, etc.
- Cognition decreased, Lhermitte’s sign in spine
- Brainstem e.g. diplopia and facial weakness
diagnosis
2 episodes of suggestive demyelination disseminated in time and place
MRI T2 weighted
CSF has oligoclonal bands
DD
vasculitis granulomatous disease vascular disease lesions infection metabolic
management of acute exacerbation of MS symptoms
mild/moderate= observe or give oral steroids (methylprednisolone) severe= admit and give IV steroids
disease-modifying therapy in MS
first line= tecfidera
second= monoclonal antibodies (tysabari, ocreumus)
third line= HSCT, mitoxantrone
symptom management in MS
cannabis sativ
pyramidal= baclofen, physiotherapy
sensory= pain with anticonvulsants, antidepressants
