Multiple Sclerosis and Inflammatory CNS disease Flashcards
At what age is the typical presentation of MS?
30s and 40s
describe the 4 different courses of MS
how common are they?
Relapsing remitting is the most common (80%)
but 60% of RR develop secondary progressive
Primary Progressive (10%)
what are the signs and symptoms of optic neuritis and how would you diagnose?
sudden painful visual loss
sight usually returns after 1-2 weeks
colour desaturation
RAPD- Relative Afferent Pupillary Defect
Diagnosis MRI
what would be the signs and symptoms of cerebellar dysfunction?
ataxia,
intention tremor
past pointing
nystagmus
dysdiodokinesis
pendular reflexes,
dysarthria
what are the urinary symptoms of MS?
lfrequency
nocturia
urgency
urge incontinence
retention
what are the signs of Internuclear ophthalmoplegia?
What is the cause?
Diplopia
Failure to adduct one eye
Nystagmus in the abducted eye
lag
caused by damage to medial longitudinal fasciculus which permits conjugated eye movements
where is the lesion likely to be when they patient is experiencing diplopia and can’t abduct their left eye. They are also experiencing weakness on the left side of their face
lesion in right brainstem and affectiong cranial nerves VI and VII
what are the clinical features of MS?
Pyramidal dysfunction (spasticity, increased tone, weakness, extensors of upper limbs and flexors of lower limbs)
Optic neuritis
Sensory symptoms (paraesthesia, numbness, pain, loss of proprioception, trigeminal neuralgia)
Lr urinary tract dysfunction
Cerebellar & brain stem features
Cognitive impairment (reduced attention span, heavy fatigue)
How is MS diagnosed?
Demonstration of lesions dissiminated in time and space.
at least 2 episodes suggesting demyelination
MRI reveals lesion
CSF- 90% have oligoclonal bands og IgG
Do bloods to rule out other causes
what are the treatment options for spasticity?
Education
Physiotherapy
Oral medication - baclofen,tizanidine
I.M. Botulinum toxin
Nerve blocks
Intrathecal baclofen / phenol
Surgery (tendon release, or cutting nerve)
what treatments are there for urinary tract dysfunction?
Anti cholinergics- oxybutynin
Demopressin
Catheters when there is no control
how is fatigue treated in MS?
Amantadine
Modafinil
what are the first line therapies for MS
»Interferon Beta – Avonex, Rebif, Betaseron, Extavia
»Glitiramer Acetate (Copaxone)
»Tecfedira
what are the second line therapies?
»Tysabri
»Fingolimod
what is the mechanism of tysabri?
what is a risk of using tysabri?
activation of John Cunningham Virus which causes Progressive Multifocal Leukoencephalopathy
when is mitoxantrone used?
how is it given?
What is the risk?
for relapsing progressive MS
12 infusions over two years
cardiac toxicity
