Topic 25 Multiple sclerosis

Question 1

Define MS

Answer 1

MS: a chronically progressive acquired disease of the CNS characterised by demyelinated lesions called plaques

Question 2

Aetiology/ cause of MS

Answer 2

The damage to myelin in MS may be due to an abnormal response of the body’s immune system, that is the body attacks its own myelin

Question 3

Epidemiology

Answer 3

Geographical distribution: high, mod & low areas of risk(temperate climate high risk)
Migration from high to low risk area before age 15, adopt risk factor of new home
Caucasian population affected > others
Females affected > males

Question 4

Pathology of MS

Answer 4

-Sharply demarcated lesion devoid of myelin, usually focal
-Inflammation and oedema of the myelin sheaths resulting in demyelination
-Sites of predilection:
optic nerve, optic chiasm, basis pontis, spinal cord,periventricular white matter

Acute lesion then chronic inactive

Question 5

Describe and acute lesion and a chronic inactive lesion

Answer 5

-Acute lesion
(oedema and immunoglobulins are present) pink to chalky white
-lysis of oligodendrocytes(death of by breaking of the cellular membrane, causing the contents to spill out)
-breakdown of myelin
-activation of astroglial processes

Chronic, inactive lesion

• no oedema or inflammation
• lesions associated with some remyelination, astrocytic process transforms acute lesion into glial scar called plaques
• as lesion increases in age lipid products of myelin breakdown are phagocytosed leaving only traces of lipid

Question 6

Classification of MS by clinical course/types

Answer 6

Relapsing-Remitting MS causes worsening of symptoms (exacerbations) that occur with increasing frequency, along with periods of reduced symptoms (remission).

Primary progressive MS causes steady progression of symptoms with few periods of remission.

Secondary progressive MS is initially similar to relapsing-remitting MS and eventually progresses to MS with no remission.

Progressive Relapsing and Remitting MS causes accumulative damage during exacerbations and remissions.

Question 7

Define Relapsing-Remitting MS

Answer 7

causes worsening of symptoms (exacerbations) that occur with increasing frequency, along with periods of reduced symptoms (remission)

Question 8

Define Primary progressive MS

Answer 8

causes steady progression of symptoms with few periods of remission.

Question 9

Define Secondary progressive MS

Answer 9

is initially similar to relapsing-remitting MS and eventually progresses to MS with no remission.

Question 10

Define Progressive Relapsing and Remitting MS

Answer 10

causes accumulative damage during exacerbations and remissions.

Question 11

Classification of Ms by clinical manifestations

Answer 11

spinal
brainstem
cerebellar
cerebral

Question 12

Signs and symptoms Impairments of MS

Answer 12

sensory impairment
motor impairment
spasticity (cerebral,spinal, brainstem)
paresis (cerebral, spinal brainstem)
ataxia (cerebellum, cerebellar tracts)
fatigue
visual impairment
bowel/bladder dysfunction
sexual dysfunction
cognitive/behavioural disturbances (cerebral)
Because of the predilection of plaques for the optic nerves, most MS patients present with visual
loss (optic neuritis).
Spinal lesions cause paralysis and sensory loss (transverse myelitis).
“other plaques may be clinically silent, whereas the optic and spinal lesions always cause symptoms.

Question 13

Typical Clinical Presentation of MS

Answer 13

blurred vision
diplopia
vertigo
numbness, tingling in limbs, trunk, face
unsteady gait
focal weakness or incoordination
difficulty with urination
impotence