Multiple sclerosis Flashcards

1
Q

Describe the pathophysiology of MS

A

Inflammatory plaques of demyelination in the CNS disseminated in time and space (occurring at multiple sites with >30days between attacks)
Demyelination heals poorly, eventually causing axonal loss

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2
Q

What causes MS?

A

Unknown
Environment plus genetics
Vitamin D deficiency

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3
Q

What is the mean age of onset of MS

A

30yo

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4
Q

Which gender does MS affect more?

A

Females

3:1 F:M

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5
Q

Describe the presentation of MS

A

Monosymptomatic
20% present with unilateral optic neuritis
Corticospinal tract
Sensory - dysesthesia, pins and needles decreased vibration sense, trigeminal neuralgia
Motor - Spastic weakness, myelitis
Sexual/GU - bladder involvement, erectile dysfunction, urine retention, incontinence, anorgasmia
GI - swallowing, constipation
Eye - diplopia, hemianopia, optic neuritis, visual phenomena, bilateral internuclear ophthalmoplegia, pupil defects
Cerebellum - trunk and limb ataxia, intention tremor, scanning, falls, speech
Cognitive and visuospatial decline

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6
Q

What may exacerbate symptoms of MS?

A

Heat - baths and exercise

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7
Q

What tests may be done to diagnose MS

A

MRI - sensitive but not specific for plaque detection
CSF - oligoclonal bands of IgG on electrophoresis that are not present in the serum, suggest CNS inflammation
Evoked potentials - delayed visual acuity, auditory and somatosensory evoked potentials

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8
Q

Which criteria is used to diagnose MS

A

McDonald criteria

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9
Q

Describe the evidence needed for diagnosis of MS in the McDonald criteria

A

Evidence of dissemination in time and space plus clinical presentation. >2 attacks and >2 objective clinical lesions

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10
Q

Describe the progression of MS

A

Relapsing remitting course with initial recovery in between relapses
With time, remission becomes incomplete and so disability accumulates

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11
Q

List some poor prognostic signs

A
Older age
Male
Motor signs at onset
Many early relapses 
Many MRI lesions
Axonal loss
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12
Q

Describe the effect of pregnancy on MS

A

Does not alter the rate of progression

Relapses may reduce during pregnancy and increase 3-6months after, but return to their previous rate thereafter

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13
Q

Describe the management of MS

A

Lifestyle
Disease modifying drugs
Treat relapses
Symptom control

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14
Q

What lifestyle measures may be advised in the management of MS

A

Regular exercise, stopping smoking, avoiding stress

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15
Q

List some disease modifying drugs

A

Dimethyl fumarate
Alemtuzumab
Natalizumab

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16
Q

Describe alemtuzumab

A

Monoclonal antibodies

Act against T cells

17
Q

Describe natalizumab

A

Monoclonal antibodies

Acts against VLA4 receptors that allow immune cells to cross the blood brain barrier

18
Q

What drug is given to treat relapses

A

Methylprednisolone 0.5-1g/24h/IV/PO for 3-5days shortens acute relapses
Use sparingly
Does not alter overall prognosis

19
Q

Which drugs are given to treat spasticity

A
Baclofen
Gabapentin 
Tizanidine 
Dantrolene
Benzodiazepines
20
Q

Which drugs are given to treat tremor

A

Botulinum toxin type A injections

21
Q

Which drugs are given to treat urinary urgency/frequency

A

Self catheterization if >100ml residual volume

Tolterodine if <100ml residual volume

22
Q

What may help treat fatigue in MS

A

CBT
Amantadine
Exercise

23
Q

List some MS eponyms

A
Devic's syndrome
Lhermitte's sign 
Uhthoff's phenomenon 
Charles Bonnet syndrome 
Pulfrich effect
Argyll Robertson pupil
24
Q

Describe devic’s syndrome

A

MS variant with transverse myelitis - loss of motor, sensory, autonomic reflex and sphincter function below the level of the lesion
Optic atrophy
Anti-aquaporin 4 antibodies

25
Describe Lhermitte's sign
Neck flexion causes electric shocks in trunk/limbs
26
What conditions is Lhermitte;s sign seen in?
MS Cervical spondylosis Cord tumours B12 deficiency
27
Describe Uhthoff's phenomenon
Worsening of symptoms with heat
28
Describe Charles bonnet syndrome
Decreased acuity/temporary blindness with complex visual hallucination of faces, shapes and animals
29
Describe Pulfrich effect
Unequal eye latencies, causing disorientation in traffic as straight trajectories seem curved and distances are misjudged on looking sideways