Multiple Sclerosis

Question 1

Define Multiple Sclerosis

Answer 1

Inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 areas of the CNS (brain, spinal cord, optic nerves) disseminated in time and space

Progressive or relapsing-remitting (or combinations)

Question 2

Aetiology of Multiple Sclerosis

Answer 2

Immune mediated (T cell) inflammatory process resulting in demyelination and axonal degeneration in the brain and spinal cord

HLA and Interleukin genes implicated
Inherited
Relapses can be triggered by infections or postnatal hormonal changes

Question 3

Risk factors for Multiple Sclerosis

Answer 3

Female
First degree relative with MS
Genetic, smoking, vit D deficiency, autoimmune diseases, EBV

Question 4

Epidemiology of Multiple Sclerosis

Answer 4

Most commonly diagnosed between 20-30
May be in the paediatric group
Most common neurological disability among young adults
European descent individuals are most commonly affected
Black Americans have more aggressive courses

Question 5

Symptoms of Multiple Sclerosis

Answer 5

Fatigue
Visual disturbance in one eye (optic neuritis - Graying or blurring of vision (looking through petroleum jelly) or vision loss | pain in moving the eye)
Diplopia
Peculiar sensory phenomena (patch of wetness of burning | hemibody sensory loss or tingling)
Lhermittes’: electrival shock sensation extending down the cervical spine -> limbs when one flex/extends the neck
Foot dragging or slapping
Leg cramps
Urinary frequency or bowel dysfunction (constipation)
Imbalance/incoordination

Uhtoff’s: symptoms worsen when warm (after a bath)

Question 6

Signs of Multiple Sclerosis on examination

Answer 6

Spasticity
Hypertonia
Hyperreflexia (especially in deep tendons)
Imbalance/incoordination - WIDE-based gait and/or limb ataxia
Colour blindness
Abnormal eye movements

Fundoscopy - blurred or pale optic disc

Question 7

Investigations for Multiple Sclerosis

Answer 7

Clinical diagnosis: 2 separate events disseminated in time and space in the absence of an alternative diagnosis

MRI brain: Periventricular white matter lesions (hyperintensities) that may not match the clinical picture, demylinated plaques
MRI spinal cord: demyelinating lesions

LP + CSF evaluation: oligoclonal bands and elevated IgG and IgG synthesis that is UNMATCHED with serum(glucose, protein, cell count normal)

FBC: normal
Metabolic panel: normal
TFTs: normal
Vit B12: normal