Multiple Sclerosis and Inflammatory CNS Disease Flashcards
what is MS?
inflammatory demyelinating disorder of the CNS in which there is plaques disseminated in time and place
when does MS typically initially present?
30s and 40s
what is ratio of females : males in MS?
3:1
what are the clinical features of MS?
pyramidal dysfunction
optic neuritis
sensory symptoms
lower urinary tract dysfunction
cerebellar and brain stem features
cognitive impairment
what are the symptoms of pyramidal dysfunction?
increased tone
spasticity
weakness
in which part of upper and lower limbs does pyramidal dysfunction occur?
extensors of upper limbs
flexors of lower limbs
what are the symptoms of optic neuritis?
painful visual loss which happens for 1-2 weeks
RAPD
which sensory symptoms are present in MS?
pain
paraesthesia
dorsal column loss (proprioception and vibration)
numbness
trigeminal neuralgia
what are symptoms of cerebellar dysfunction?
dysarthria
ataxia
nystagmus
intention tremor
past pointing
pendular reflexes
dysdiadokinesis
what are symptoms of brain stem dysfunction?
diplopia = R VI palsy
facial weakness = R VII palsy
internuclear ophthalmoplegia
what causes internuclear ophthalmoplegia?
lesion in medial longitudinal fasciculus
what are symptoms of internuclear ophthalmoplegia?
distortion of binocular vision
failure of adduction - diplopia
nystagmus in abducting eye
lag
what are symptoms of lower urinary tract dysfunction?
frequency
nocturia
urgency
urge incontinence
retention
what is given to treat fatigue in MS?
amantadine
modafinil if sleepy
hyperbaric oxygen
what is criteria for diagnosis of MS?
at least 2 episodes suggestive of demyelination
dissemination in time and place
alternative diagnosis excluded
what investigations help in diagnosing MS?
clinical
MRI
CSF
neurophysiology
blood tests
what are differential diagnosis of MS?
vasculitis granulomatous disorder vascular disease structural lesion infection metabolic disorder
what is present in CSF in 90+% of MS cases?
oligoclonal bands
what is given in mild acute exacerbation of MS?
symptomatic treatment
what is given in moderate acute exacerbation of MS?
oral steroids
what is given in severe acute exacerbation of MS?
admit / IV steroids
how would you symptomatically treat pyramidal dysfunction (weakness and spasticity)?
physiotherapy
occupational therapy
anti spasmodic agent
what different types of anti spasmodic agents can be used?
oral - baclofen, tizanidine
botulinum toxin
intrathecal baclofen / phenol
how would you treat sensory symptoms (pain, paraesthesia, numbness, trigeminal neuralgia)?
anti convulsant - gabapentin
anti depressant - amitriptyline
tens machine
acupuncture
lignocaine infusion
how do you symptomatically treat lower urinary tract dysfunction?
bladder drill
anti cholinergics - oxybutynin
desmopressin
catheterisation
what is the three stages of MS therapy?
acute exacerbation
symptomatic treatment
disease modifying therapy
what is the first line disease modifying therapy for MS?
interferon beta - avonex, rebif, betaseron, extavia
glitiramer acetate
tecfidera, aubagio
what is second line disease modifying therapy for MS?
monoclonal antibody - tysabri, ocrevus
fingolimod, cladrabine
what is third line disease modifying therapy for MS?
mitoxantrone, lemtrada
HSCT (stem cell transplant)
how are interferons and glitiramer acetate given and what is their effectiveness?
injectable - sc and im
decrease relapse rate by a 1/3 and severity of relapse by 50%
how is tecfidera given and what is effectiveness?
oral agent which is first line in relapsing remitting MS
44% reduction in relapse rate
how do fingolimoid / cadrabine given and what is their effectiveness?
oral agents which NICE have approved as second line
> 50% reduction in relapse rate
when is tysabri given?
single disease modifier given in highly active RRMS
pts with rapidly evolving severe RRMS and pts with high disease activity despite treatment with interferon
when should tysabri not be given?
when patient is JC virus positive
if given - develop PML
what is really good about interferon beta?
can give in pregnancy
what is the role of a4B1 in MS?
trans-endothelial migration of activated T cells across BBB in EAE mediated by integrins
