Multiple Sclerosis (MS)

Question 1

What is the pathology of MS?

Answer 1

MS is a the presence of multiple lesions in the CNS.
Plaques and demyelination causes axonal degeneration of the optic nerve, spinal cord, brainstem and periventricular areas

Question 2

What are the clinical features of MS?

Answer 2

Eyes:

• Optic neuritis (increasingly blurred vision in one eye, may progress to blindness in that eye. Central vision more severely effected.
• diplopia

-Motor weakness (more common in arms)

Sensory symptoms

• parasthesia (burning, prickling sensation)
• dyasthesia
• proprioceptive disorders —> sensory ataxia, incoordination
• diminished vibration sense

Cerebellar signs:

• nystagmus
• dyssynergia (inco-ordinated, abrupt movements)
• dysdiadochokinesia
• incoordination of heel-shin test
• intention tremor
• titubation (tremor of head and trunk)
• dysarthria (slurred speech)
• hypotonic reflexes

Cognitive impairment (memory, lack of concentration)

Psychiatric (depression)

Pain

Bladder disturbance (frequency, urgency, incontinence)

Question 3

Optic neuritis is a symptom of MS - what does this entail?

Answer 3

• increasingly blurred vision in one eye
• can progress to uniocular blindness
• eye may be painful
• colour vision affected

Question 4

Diplopia is a symptom of MS - what nerves are affected in order for this to occur?

Answer 4

Diplopia is caused by brainstem plaque involving 3rd (ocular motor), 4th (trochlear), or 6th (abducens) cranial nerves

Question 5

What are the differential diagnoses of MS?

Answer 5

• SLE
• primary Sjogren’s syndrome
• Lyme disease
• multiple emboli
• sarcoidosis
• wegener’s granulomatosis

Question 6

What investigations are done for MS?

Answer 6

1) Lumbar Puncture:
- CNS shows lymphocytosis and raised protein
- oligoclonal bands are seen 90% of MS cases, but is not diagnostic.

2) MRI ( to identify plaques)
3) Antibodies to myelin basic protein and myelin oligodenrocyte glycoprotein may be present.

Question 7

What is the management of MS?

Answer 7

• there is no cure for MS.
• physiotherapy
• treat spasticity with baclofen, dantrolene or vigabatrin
• treat intention tremor with isoniazid, pyridoxine or beta blockers.
• treat trigeminal neuralgia with carbamezapine.

Question 8

What are the cerebellar signs of MS?

*remember VANISH’D

Answer 8

• nystagmus
• dyssynergia (intention tremor)
• dysdiadochokinesis
• incoordination of shin to heel test
• titubation (tremor of head and trunk)
• dysarthria (slurred speech)

VANISH'D
V - vertigo
A - ataxia
N - nystagmus
I - Intention tremor
S - Slurred speech
H - hypotonic reflexes
D - dysdiadochokinesis