Station 3.15: Multiple sclerosis Flashcards
Multiple sclerosis
Clinical signs
What are the clinical signs of Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
- Inspection: ataxic handshake and wheelchair
- Cranial nerves: internuclear ophthalmoplegia (frequently bilateral in MS), optic atrophy, reduced visual acuity, and any other cranial nerve palsy
- Peripheral nervous system: Upper‐motor neurone spasticity, weakness, brisk reflexes and altered sensation
- Cerebellar: ‘DANISH’ (see cerebellar syndrome section)
Discussion - Diagnostic Criteria
What is the diagnostic criteria for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
Central nervous system demyelination (plaques) causing neurological impairment that is disseminated in both time and space.
Discussion - cause
What is the cause for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
Unknown, but both genetic – (HLA‐DR2, interleukin‐2 and ‐7 receptors) and environmental factors (increasing incidence with increasing latitude, association with Epstein–Barr virus infection) appear to play a role
Discussion - cause
What is the investigation: clinical diagnosis plus for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
- CSF: oligoclonal IgG bands
- MRI: periventricular white matter plaques
- Visual evoked potentials (VEPs): delayed velocity but normal amplitude (evidence of previous optic neuritis)
Discussion - Other clinical features
What are other clinical features for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
* Higher mental function: depression, occasionally euphoria
* Autonomic: urinary retention/incontinence, impotence and bowel problems
Uthoff’s phenomenon: worsening of symptoms after a hot bath or exercise
Lhermitte’s sign: lightening pains down the spine on neck flexion due to cervical cord plaques
Discussion - Treatment Multidisciplinary approach
What is the Treatment (Multidisciplinary approach) for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
Multidisciplinary approach
Nurse, physiotherapist, occupational therapist, social worker and physician.
Discussion - Treatment Disease modifying treatments
What is the Treatment (Disease modifying treatments) for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
- Interferon‐beta and Glatiramer reduce relapse rate but don’t affect progression.
- Monoclonal antibody therapy potentially offers greater benefits; reducing disease progression and accumulated disability, e.g. Alemtuzumab (anti‐CD52) – lymphocyte depletion, Natalizumab (anti‐α4 integrin) – blocks T‐cell trafficking. Toxicity may limit their use.
Discussion - Treatment Symptomatic treatments
What is the Treatment (Symptomatic treatments) for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
- Methyl‐prednisolone during the acute phase may shorten the duration of the ‘attack’ but does not affect the prognosis.
- Anti‐spasmodics, e.g. Baclofen.
- Carbamazepine (for neuropathic pain).
- Laxatives and intermittent catheterization/oxybutynin for bowel and bladder disturbance.
Discussion - Treatment prognosis
What is the prognosis for Multiple sclerosis?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
Variable: The majority will remain ambulant at 10 years
Discussion - MS and pregnancy
Discuss MS and pregnancy?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
- Reduced relapse rate during pregnancy
- Increased risk of relapse in postpartum period
- Safe for foetus (possibly reduced birth weight)
Discussion - Impairment, disability and handicap
Discuss Impairment, disability and handicap?
Multiple sclerosis
This 30‐year‐old woman complains of double vision and incoordination with previous episodes of weakness. Please perform a neurological examination.
- Arm paralysis is the impairment
- Inability to write is the disability
- Subsequent inability to work as an accountant is the handicap
Occupational therapy aims to help minimize the disability and abolish the handicap of arm paresis.
