Multiple Sclerosis (Hon)

Question 1

What is a typical classic 1st presentation symptom of multiple sclerosis (MS)?

Answer 1

optic neuritis; loss of vision, loss of color vision (typically one eye); associated with pain with movement of the eye

Question 2

A patient presenting with waxing and waning of neurological symptoms and optic neuritis, should make you consider what diagnosis?

Answer 2

Multiple sclerosis (MS)

Question 3

Dignosis of MS

Answer 3

multiple lesions over space and time

Question 4

Definition of MS

Answer 4

disorder of brain and spinal cord characterized by increasing and decreasing symptoms and signs that result from myelin loss at multiple sites in the CNS

Question 5

What are some common neurological symptoms of MS?

Answer 5

paresthesias
gait disturbances (transverse myelitis)
weakness
visual loss (optic neuritis)

Question 6

What are the 4 types of MS?

Answer 6

1. Relapsing remitting (50%)
2. Secondary progressive - about 25% from remitting progress here
3. Primary progressive (20%)
4. Benign (10%) - very very mild symptoms (maybe one or two execrations in lifetime)

Question 7

Favorable prognosis of MS

Answer 7

women and onset at younger age

Question 8

MRI of head and cervical and thoracic spine findings in MS?

Answer 8

ovoid lesions in periventricular white matter and spinal cord

Question 9

What are you looking for in a lumbar puncture of someone you suspect of MS?

Answer 9

oligoclonal bands and/or elevated IgG index/synthesis (more IgGs in spinal fluid compared to blood)

Question 10

Treatment of an acute MS episode?

Answer 10

high dose steroids via IV for 3-5 days; if cannot tolerate use ACTH (gel) to stimulate endogenous steroid production (expensive)

Question 11

The only drug FDA approved for Primary Progressive MS?

Answer 11

Ocrevus; some patients progress so slowly they prefer to not take the agent

Question 12

Clinically Isolated Syndrome (CIS)

Answer 12

monofocal episode - person has single neurological sign or symptoms that’s caused by a single lesion (20% chance of progressing to MS)

Question 13

Acute Disseminated Encephalomyelitis (ADEM)

Answer 13

multifocal episode - person has more than one sign or symptoms caused by lesions in more than one place (80% chance progressing to MS) - missing time variable to be diagnosed with MS

Question 14

Most approved FDA drugs for MS are for which type?

Answer 14

Relapsing remitting

Question 15

Devic’s disease (Neuromyelitis Optica)

Answer 15

characterized by inflammation and demyelination of the optic nerves and spinal cord with sparing of the brain; lesions are longer and bigger; prognosis is worse than MS and symptoms are more aggressive; doesn’t respond well to MS therapies