Multiple Sclerosis Tutorial

Question 1

What is Multiple Sclerosis and describe it’s Pathophysiology

Answer 1

A chronic inflammatory demyelinating disease of the CNS.

A type 4 hypersensitivity reaction which can also direclty affect oligodendrocyte. Hence axons are destroyed and plaques are formed

it shows an exerceabting remitting pattern.

Early on in the progression, there could be remyelination but overtime that stops

Question 2

Describe the onset and symptoms of multiple sclerosis

Answer 2

Affects females more but normally starts as relapsing-remitting

Symptoms vary a lot and depends on where the plaque forms in CNS.

MS is associated with Charcot’s triad:

• Dysarthria - difficult or unclear speech
• Nystagmus -involuntray eye movements
• Intention tremor

Question 3

what are the causes of Multiple sclerosis

Answer 3

Cause is unknown but there’s are factors that increases chance of getting MS

Question 4

What are the clinical subytpes of multiple sclerosis ?

Explain each one by drawing graph of diabiltiy across time

Answer 4

• Relapsing-remitting- most common
• Secondary progressive
• Primary progressive
• Progressive relapsing

Question 5

What are the methods of diagnosing Multiple sclerosis ?

Answer 5

Look at clinical history before going into the different investigations

MRI- look for white spots

CSF analysis- increased Ig in CSF. Also there’s oligoclonal bands

Visual evoked potential- pt with MS find it uncomfortable to the change in lots of stimulus compared to normal.

Brain and nerve stimulation techniques

Question 6

How can brain and nerve stimulation be used to diagnose Multiple sclerosis

Answer 6

Carry out TMS accordingly to find TMS latency top muscle fibre

Then do peripheral nerve latency- using the formula in pic

Central latency= TMCT latency- Peripheral nerve latency. (PMCT) The higher the central latency the more chance of having MS.

if TMCT is delayed but PMCT is normal then the problem is in CNS (MS)

Question 7

what are the therapeutic options for MS

Answer 7

• Immuno-modulatory and immunosuppressive treatments can be used to try to reduce relapses.
• Treat specifc symtoms like pain, spasticity, bladder dysfunction.

Question 8

what causes M waves, F waves and H reflex

Answer 8

M waves- stimulus goes directly ORTHODROMICALLY straight to motor fibres.

H reflex; lower stimulus travel to CNS then come back down motor fibres and then cause twitching

F waves- LARGE stimulus travel ANTIDROMICALLY up motor neurones then synapse and come back down motor neurone to muscle. (NOT a reflex)