Multiple Sclerosis (MS)

Question 1

What is MS?

Answer 1

Chronic, progressive, autoimmune neurological condition against the myelin cells in the CNS (brain, brainstem spinal cord)

Question 2

What cells produce myelin in the CNS and PNS?

Answer 2

• PNS: Schwann cells

- CNS: oligodendrocytes

Question 3

Types of MS?

Answer 3

1. Clinically isolated syndrome - 1st presentation
2. Relapsing and Remitting - episodes of disease then recovery
3. Primary Progressive - symptoms worsen from point of diagnosis
4. Secondary Progressive - RRMS turns into progressive

Question 4

Symptoms of MS? (5)

Answer 4

1. optic neuritis
2. ophthalmoplegia/eye muscle weakness: Sixth Nerve Palsy
3. Focal weakness (bladder and bowel incontinence, limb paralysis)
4. Focal sensory loss (numbness, paraesthesia)
5. Ataxia

Question 5

What type of ophthalmoplegia/muscle palsy does MS present with? What are its 2 characteristic features?

Answer 5

1. Sixth Nerve Palsy

2. Intra-nuclear Ophthalmoplegia and Conjugate Lateral Gaze Disorder

Question 6

What type of demographics does MS typically present in?

Answer 6

Young females (<50 years)

Question 7

Investigations for MS?

Answer 7

Bedside: neuro exam, fundoscopy
Bloods: FBC, CRP, U&E, LFTs, TFTs, glucose, haematinics, bone profile, blood-born virus screen
Imaging:

Question 8

Investigations for MS?

Answer 8

Bedside: neuro exam, fundoscopy
Bloods: FBC, CRP, U&E, LFTs, TFTs, glucose, haematinics, bone profile, blood-born virus screen
Imaging/Special Tests: MRI brain, LP

Question 9

Management of an acute episode of MS?

Answer 9

1. Steroids - methylprednisolone

Question 10

Management of an acute episode of MS/ induce remission?

Answer 10

Steroids - methylprednisolone (think PPI/bone protection)

Question 11

Treatment to maintain remission in MS?

Answer 11

Disease modifying drugs (e.g. Interferon beta)

Question 12

Symptomatic treatment of MS? (6)

Answer 12

1. pain (neuropathic - amitriptyline, gabapentin, pregabalin)
2. gait (OT/PT referral, walking aids etc.)
3. bladder (anticolinergics - oxybutinin)
4. bowels (laxatives, enemas, dietary changes)
5. depression (SSRIs)
6. spasticity (baclofen, gabapentin)

Question 13

Complications of MS?

Answer 13

Development of permanent symptoms

Question 14

Does the symptoms worsen or improve in pregnancy and post-partum?

Answer 14

1. pregnancy - improves

2. post-partum - worsens

Question 15

Management of optic neuritis?

Answer 15

1. Urgent referral to opthalmology

2. steroids