Multiple Sclerosis and inflammatory CNS disease Flashcards
The F:M ratio for MS is?
3:1
What are the clinical features of MS?
- Pyramidal dysfunction
- Optic neuritis
- Sensory symptoms
- Lr urinary tract dysfunction
- Cerebellar and brain stem features
- Cognitive impairement
What are the features of pyramidal dysfunction?
- Increased tone
- spasticity
- weakness
- extensors of upper limbs
- flexors of lower limbs
What is optic neuritis?
Painful visual loss
1 to 2 weeks
Most improve
What is a clinical sign of optic neuritis?
RAPD
What are the sensory symptoms of MS?
Pain Paraesthesia Dorsal column loss - proprioception and vibration Numbness Trigeminal neuralgia
Describe cerebellar dysfunction in MS?
Dysarthria Ataxia Nystagmus Intention tremor Past pointing Pendular reflexes Dysdiodokineses
What may be seen in brain stem dysfunction?
Diplopia
Facial Weakness
What is the clinical presentation of internuclear ophthalmoplegia?
- Distortion of binocular vision
- Failure of adduction - diplopia
- Nystagmus in abducting eye
- Lag
What part of the brainstem causes internuclear ophthalmoplegia
Medial longitudinal fasciculus
Describe lower urinary tract dysfunction in MS?
Frequency Nocturia Urgency Urge incontinence Retention
How can fatigue in MS be managed?
Amantadine
Modafinil if sleepy
Hyperbaric oxygen
How is MS diagnosed clinically?
At least 2 episodes suggestive of demyelination
Dissemination in time and place
Alternative diagnosis excluded
Which investigations are done for MS?
MRI
CSF
Neurophysiology
Blood tests
List some differential diagnoses of MS
Vasculitis Granulomatous disorder Vascular disease Structural lesion Infection Metabolic disorder
What is found in CSF?
Oligoclonal bands in CSF
What are the treatment options for spasticity?
Physiotherapy Oral medication - baclofen, tizanidine Botulinum toxin Intrathecal baclofen/phenol
What are the options for sensory symptoms of MS?
Anti convulsant e.g. gabapentin
Anti depressant e.g.amitriptyline
Tens machine
Acupuncture
Lignocaine infusion
Describe urinary dysfunction in MS?
- Increased tone at bladder neck
- Detruser hypersensitivity
- Detruser sphyncteric dyssenergia
What are the treatment options for Lr urinary tract dysfunction in MS?
Bladder drill
Anti cholinergic e.g. oxybutynin
Desmopressin
Catheterisation
What is the first line disease modifying therapy?
- Interferon beta- Avonex, rebif, Betaseron, extavia
- Glitiramer acetate
- Tecfedira, aubagio
What is the second line disease modifying therapy?
- Monoclonal antibody- tysabri, ocrevus
- Fingolimod, cladrabine
What is the third line disease modifying therapy?
Mitoxantrone, lemtrada
HSCT (stem cell transplantation)
Interferons & glitiramer acetate are ________ agents (__,__)
They decrease relapse rate by / and decrease the severity of relapses by __%
Interferons & glitiramer acetate are injectable agents (sc,im)
They decrease relapse rate by 1/3 and decrease the severity of relapses by 50%
Tecfidera is an ____ agent, it is the first line agent in __ __. It confers a __% reduction in relapse rate
Tecfidera is an oral agent, it is the first line agent in RR MS. It confers a 60% reduction in relapse rate
Fingolimod and cadrabine are ____ agents, they confer a >__% reduction on relapse rate
Fingolimod and cadrabine are oral agents, they confer a >50% reduction on relapse rate
Who is eligible for treatment with tysabri?
Patients with rapidly evolving severe relapsing remitting MS
Patients with high disease activity despite treatment with alpha interferon
Trans-endotherlial migration of activated T-cells across ___ in EAE mediated by _______
Trans-endotherlial migration of activated T-cells across BBB in EAE mediated by integrins
Describe the inflammatory cascade in MS?
- immune cells pass through blood-brain barrier
- immune cells may re-activate and produce cytokines
- immune cells mount attack against myelin
