Multiple Sclerosis

Question 1

What is MS?

Answer 1

Inflammatory plaques of demyelination in the CNS disseminated in space and time

Question 2

What are the three patterns of MS?

Answer 2

Relapsing-remitting, secondary progressive, primary progressive

Question 3

What spinal tract is commonly involved?

Answer 3

Corticospinal

Question 4

What might you see on an MRI?

Answer 4

Lesions, can also help exclude other causes

Question 5

What test would you do on CSF from a LP?

Answer 5

Electrophoresis to look for IgG that aren’t in serum

Question 6

What criteria is used to diagnose MS?

Answer 6

McDonald criteria

Question 7

What diagnostic criteria needs no testing?

Answer 7

2 or more attacks with 2 or more objective clinical lesions

Question 8

What lifestyle advice should you give?

Answer 8

Regular exercise, stop smoking, avoid stress

Question 9

What drugs are available for chronic MS?

Answer 9

Dimethyl fumarate, interferon beta, fingolimod, natalizumab

Question 10

What do the monoclonal antibodies act against?

Answer 10

T cell receptors that allow immune cells to cross the blood brain barrier

Question 11

What drug can help shorten acute relapses?

Answer 11

Methylprednisolone

Question 12

What are some potential complications?

Answer 12

UTIs, osteopenia and osteoporosis, depression, visual impairment, ED

Question 13

Describe relapsing-remitting MS

Answer 13

Symptoms come and go, periods of good health followed by sudden symptoms

Question 14

Describe secondary progressive MS

Answer 14

Follows from relapsing-remitting, gradually worsening symptoms with fewer remissions

Question 15

Describe primary progressive MS

Answer 15

Symptoms gradually develop and worsen over time with no remitting

Question 16

What symptoms would you get?

Answer 16

Pyramidal weakness, spastic paraparesis, changes in sensation, fatigue, chronically increasing bladder involvement, cognitive impairment, dizziness, depression

Question 17

What does pyramidal weakness affect?

Answer 17

Upper limb extensions, lower limb flexors

Question 18

What signs would you get?

Answer 18

Usually UMN, loss of colour vision, Lhermitte sign, Uhthoff phenomenon

Question 19

What is the Lhermitte sign?

Answer 19

Electric jolt felt down the spine when flexing neck

Question 20

What is the Uhthoff phenomenon?

Answer 20

Symptoms worse with heat

Question 21

What is the gold standard investigation?

Answer 21

MRI

Question 22

Who do you have to notify legally?

Answer 22

DVLA

Question 23

How can you manage acute MS?

Answer 23

Steroids