Multiple Sclerosis and Inflammatory CNS Disease

Question 1

what is MS?

Answer 1

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

Question 2

when does MS typically initially present?

Answer 2

30s and 40s

Question 3

what is ratio of females : males in MS?

Answer 3

3:1

Question 4

what are the clinical features of MS?

Answer 4

pyramidal dysfunction

optic neuritis

sensory symptoms

lower urinary tract dysfunction

cerebellar and brain stem features

cognitive impairment

Question 5

what are the symptoms of pyramidal dysfunction?

Answer 5

increased tone

spasticity

weakness

Question 6

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

Answer 6

extensors of upper limbs

flexors of lower limbs

Question 7

what are the symptoms of optic neuritis?

Answer 7

painful visual loss which happens for 1-2 weeks

RAPD

Question 8

which sensory symptoms are present in MS?

Answer 8

pain

paraesthesia

dorsal column loss (proprioception and vibration)

numbness

trigeminal neuralgia

Question 9

what are symptoms of cerebellar dysfunction?

Answer 9

dysarthria

ataxia

nystagmus

intention tremor

past pointing

pendular reflexes

dysdiadokinesis

Question 10

what are symptoms of brain stem dysfunction?

Answer 10

diplopia = R VI palsy

facial weakness = R VII palsy

internuclear ophthalmoplegia

Question 11

what causes internuclear ophthalmoplegia?

Answer 11

lesion in medial longitudinal fasciculus

Question 12

what are symptoms of internuclear ophthalmoplegia?

Answer 12

distortion of binocular vision

failure of adduction - diplopia

nystagmus in abducting eye

lag

Question 13

what are symptoms of lower urinary tract dysfunction?

Answer 13

frequency

nocturia

urgency

urge incontinence

retention

Question 14

what is given to treat fatigue in MS?

Answer 14

amantadine

modafinil if sleepy

hyperbaric oxygen

Question 15

what is criteria for diagnosis of MS?

Answer 15

at least 2 episodes suggestive of demyelination

dissemination in time and place

alternative diagnosis excluded

Question 16

what investigations help in diagnosing MS?

Answer 16

clinical

MRI

CSF

neurophysiology

blood tests

Question 17

what are differential diagnosis of MS?

Answer 17

vasculitis 
granulomatous disorder
vascular disease
structural lesion 
infection 
metabolic disorder

Question 18

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

Answer 18

oligoclonal bands

Question 19

what is given in mild acute exacerbation of MS?

Answer 19

symptomatic treatment

Question 20

what is given in moderate acute exacerbation of MS?

Answer 20

oral steroids

Question 21

what is given in severe acute exacerbation of MS?

Answer 21

admit / IV steroids

Question 22

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

Answer 22

physiotherapy
occupational therapy
anti spasmodic agent

Question 23

what different types of anti spasmodic agents can be used?

Answer 23

oral - baclofen, tizanidine

botulinum toxin

intrathecal baclofen / phenol

Question 24

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

Answer 24

anti convulsant - gabapentin

anti depressant - amitriptyline

tens machine

acupuncture

lidocaine infusion

Question 25

how do you symptomatically treat lower urinary tract dysfunction?

Answer 25

bladder drill anti cholinergics - oxybutynin desmopressin catheterisation

Question 26

what is the three stages of MS therapy?

Answer 26

acute exacerbation symptomatic treatment disease modifying therapy

Question 27

what is the first line disease modifying therapy for MS?

Answer 27

interferon beta - avonex, rebif, betaseron, extavia glitiramer acetate tecfidera, aubagio

Question 28

what is second line disease modifying therapy for MS?

Answer 28

monoclonal antibody - tysabri, ocrevus fingolimod, cladrabine

Question 29

what is third line disease modifying therapy for MS?

Answer 29

mitoxantrone, lemtrada HSCT (stem cell transplant)

Question 30

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

Answer 30

injectable - sc and im decrease relapse rate by a 1/3 and severity of relapse by 50%

Question 31

how is tecfidera given and what is effectiveness?

Answer 31

oral agent which is first line in relapsing remitting MS 44% reduction in relapse rate

Question 32

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

Answer 32

oral agents which NICE have approved as second line >50% reduction in relapse rate

Question 33

when is tysabri given?

Answer 33

single disease modifier given in highly active RRMS pts with rapidly evolving severe RRMS and pts with high disease activity despite treatment with interferon

Question 34

when should tysabri not be given?

Answer 34

when patient is JC virus positive if given - develop PML

Question 35

what is really good about interferon beta?

Answer 35

can give in pregnancy

Question 36

what is the role of a4B1 in MS?

Answer 36

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