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CU Child Neurology Neuroimmunology > Multiple Sclerosis and Inflammatory CNS Disease > Flashcards

Multiple Sclerosis and Inflammatory CNS Disease Flashcards

1
Q

what is MS?

A

inflammatory demyelinating disorder of the CNS in which there is plaques disseminated in time and place

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2
Q

when does MS typically initially present?

A

30s and 40s

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3
Q

what is ratio of females : males in MS?

A

3:1

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4
Q

what are the clinical features of MS?

A

pyramidal dysfunction

optic neuritis

sensory symptoms

lower urinary tract dysfunction

cerebellar and brain stem features

cognitive impairment

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5
Q

what are the symptoms of pyramidal dysfunction?

A

increased tone

spasticity

weakness

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6
Q

in which part of upper and lower limbs does pyramidal dysfunction occur?

A

extensors of upper limbs

flexors of lower limbs

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7
Q

what are the symptoms of optic neuritis?

A

painful visual loss which happens for 1-2 weeks

RAPD

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8
Q

which sensory symptoms are present in MS?

A

pain

paraesthesia

dorsal column loss (proprioception and vibration)

numbness

trigeminal neuralgia

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9
Q

what are symptoms of cerebellar dysfunction?

A

dysarthria

ataxia

nystagmus

intention tremor

past pointing

pendular reflexes

dysdiadokinesis

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10
Q

what are symptoms of brain stem dysfunction?

A

diplopia = R VI palsy

facial weakness = R VII palsy

internuclear ophthalmoplegia

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11
Q

what causes internuclear ophthalmoplegia?

A

lesion in medial longitudinal fasciculus

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12
Q

what are symptoms of internuclear ophthalmoplegia?

A

distortion of binocular vision

failure of adduction - diplopia

nystagmus in abducting eye

lag

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13
Q

what are symptoms of lower urinary tract dysfunction?

A

frequency

nocturia

urgency

urge incontinence

retention

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14
Q

what is given to treat fatigue in MS?

A

amantadine

modafinil if sleepy

hyperbaric oxygen

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15
Q

what is criteria for diagnosis of MS?

A

at least 2 episodes suggestive of demyelination

dissemination in time and place

alternative diagnosis excluded

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16
Q

what investigations help in diagnosing MS?

A

clinical

MRI

CSF

neurophysiology

blood tests

17
Q

what are differential diagnosis of MS?

A 
vasculitis 
granulomatous disorder
vascular disease
structural lesion 
infection 
metabolic disorder
18
Q

what is present in CSF in 90+% of MS cases?

A

oligoclonal bands

19
Q

what is given in mild acute exacerbation of MS?

A

symptomatic treatment

20
Q

what is given in moderate acute exacerbation of MS?

A

oral steroids

21
Q

what is given in severe acute exacerbation of MS?

A

admit / IV steroids

22
Q

how would you symptomatically treat pyramidal dysfunction (weakness and spasticity)?

A

physiotherapy
occupational therapy
anti spasmodic agent

23
Q

what different types of anti spasmodic agents can be used?

A

oral - baclofen, tizanidine

botulinum toxin

intrathecal baclofen / phenol

24
Q

How would you treat sensory symptoms of MS (pain, paraesthesia, numbness, trigeminal neuralgia)?

A

anti convulsant - gabapentin

anti depressant - amitriptyline

tens machine

acupuncture

lidocaine infusion

25
Q

how do you symptomatically treat lower urinary tract dysfunction?

A

bladder drill

anti cholinergics - oxybutynin

desmopressin

catheterisation

26
Q

what is the three stages of MS therapy?

A

acute exacerbation

symptomatic treatment

disease modifying therapy

27
Q

what is the first line disease modifying therapy for MS?

A

interferon beta - avonex, rebif, betaseron, extavia

glitiramer acetate

tecfidera, aubagio

28
Q

what is second line disease modifying therapy for MS?

A

monoclonal antibody - tysabri, ocrevus

fingolimod, cladrabine

29
Q

what is third line disease modifying therapy for MS?

A

mitoxantrone, lemtrada

HSCT (stem cell transplant)

30
Q

how are interferons and glitiramer acetate given and what is their effectiveness?

A

injectable - sc and im

decrease relapse rate by a 1/3 and severity of relapse by 50%

31
Q

how is tecfidera given and what is effectiveness?

A

oral agent which is first line in relapsing remitting MS

44% reduction in relapse rate

32
Q

how do fingolimoid / cadrabine given and what is their effectiveness?

A

oral agents which NICE have approved as second line

> 50% reduction in relapse rate

33
Q

when is tysabri given?

A

single disease modifier given in highly active RRMS

pts with rapidly evolving severe RRMS and pts with high disease activity despite treatment with interferon

34
Q

when should tysabri not be given?

A

when patient is JC virus positive

if given - develop PML

35
Q

what is really good about interferon beta?

A

can give in pregnancy

36
Q

what is the role of a4B1 in MS?

A

trans-endothelial migration of activated T cells across BBB in EAE mediated by integrins

CU Child Neurology Neuroimmunology (6 decks)

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