Multiple Sclerosis (Hon) Flashcards
Define multiple sclerosis
Disorder of brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbations & remissions), which result from loss of nerve tract insulation (myelin) at multiple sites in CNS
MS patients can present with almost any neurological symptom. Which ones are the common ones?
Paresthesia Gait disturbances (transverse myelitis) Weakness Visual loss (optic neuritis) Urinary difficulty Dysarthria Hemiparesis
What are the 4 types of MS?
Relapsing remitting (45-50%) Secondary progressive (20-25%) (these pts begin their disease process in relapsing remitting category) Primary progressive (15-20%) Benign (10-15%)
What are some generalities of MS?
MS is a disorder of CNS
Most MS pts diagnosed in their 20’s or 30’s
Disorder is generally characterized by periods of exacerbation and remission
No single test can confirm diagnosis of MS. However, multiple studies can be used to help make diagnosis
What causes MS?
Essentially unknown
Probably some genetic susceptibility (3-5% lifetime risk of developing MS if first degree relative has MS)
Perhaps a childhood event or illness that sensitizes immune system to attack CNS myelin, followed by an adult event triggering disease process (viral infection, post-partum period)
Epidemiology of MS
Affects women more than men (1.5:1), with women generally having a more favorable course
Onset of disease between age 15-50 (average onset 29) years
-in general, earlier onset is a more favorable prognostic feature
Geographic distribution:
- tropical zones: 5-10 per 100,000
- temperate zones: 50 per 100,000 (risk determined before 14)
What studies are used to make diagnosis of MS?
MRI of head, C & T spine
-Typically see ovoid lesions of high signal on T2WI in periventricular white matter and in spinal cord. Acute lesions may enhance
Multimodality evoked potentials (SSEPs, VEPs, BAER)
Lumbar puncture for CSF analysis
-presence of oligoclonal bands and/or increased IgG index/synthesis rate are typical findings in MS patients
MS is diagnosed by ___
Multiple lesions over space and time
What drugs are used for “maintenance” in MS (to decrease frequency and severity of exacerbations and slow progression of disease)?
Avonex, Rebif (*Interferon Beta-1A) Betaseron (*Interferon Beta-1B) Copaxone (*Glatirimer acetate) Tysabri (natalizumab) Gilenya (fingolimod) Aubagio (Teriflunomide) Tecfidera (dimethyl fumarate) Lemtrada (Alemtuzumab)
In general, used in pts with relapsing forms of MS (not primary progressive)
What medications are used to treat acute exacerbation in MS?
High dose corticosteroids (solumedrol - 1 g IV daily for 3-5 days followed by prednisone taper)
Generally reduces length of exacerbation but is not thought to change overall outcome of it
What is the differential diagnosis for MS?
Nearly impossible to differentiate a first time MS attack from a post-infectious or post-immunization encephalomyelopathy (ADEM: Acute disseminated encephalomyelitis)
-ADEM should never recur, however. If pt develops future symptoms or new lesions on MRI, MS is more likely diagnosis
Autoimmune disease:
- SLE with cerebritis
- CNS vasculitis
- Polyarteritis nodosa with transverse myelitis
Others
- Devic’s disease (neuromyelitis optica)
- B12 deficiency
- lymphoma or leukemia with CNS involvement
- spinocerebellar ataxias
- vascular malformations (spinal cord AVM)
- infections (HIV, HTLV-1, EBV, CMV, West Nile Virus, Lyme disease, syphilis)
- granulomatous disease (sarcoidosis)
- metachromatic leukodystrophy, adrenomyeloleukodystrophy
What drugs treat spasticity of MS?
Baclofen (oral or intrathecal), tizanadine, diazepam, carbamazepine, Botox, dantrolene
What drugs treat intention tremor of MS?
Propranolol
Primidone
Clonazepam
What drugs treat urinary urgency (spastic bladder) of MS?
Oxybutinin
Detrol LA
What drug treats urinary retention/hesitancy of MS?
Bethanechol
