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Neurology > Week 4- MS > Flashcards

Week 4- MS Flashcards

1
Q

What is multiple sclerosis?

A

An inflammatory demyelinating disorder of the central nervous system.
Plaques are disseminated in TIME and PLACE.

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2
Q

When does multiple sclerosis initially present?

A

In the 30-40 age range.

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3
Q

What are the 4 courses that MS can follow?

A

Relapsing- remitting MS
Progressive relapsing
Secondary progressive
Primary progressive

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4
Q

Which course of MS is most common?

A

Relapsing-remitting MS.

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5
Q

Describe relapsing-remitting MS?

A

You have bouts of symptoms, then they go back to almost good health. This happens again and again.
E.g. visual loss for 2 weeks, they then regain complete vision afterwards.

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6
Q

Describe secondary progressive MS?

A

Like relapsing and remitting- they have bouts of symptoms, however they don’t recover as well afterwards. Their disability gradually increases.

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7
Q

Describe progressive relapsing MS?

A

More gradual onset of symptoms with occasional exacerbations.

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8
Q

Describe primary progressive MS?

A

They have gradual symptom onset and gradual disability worsening.

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9
Q

Clinical features of MS?

A 
Pyramidal dysfunction 
Optic neuritis (inflammation of the nerve- transient, vision loss stops when the inflammation stops)
Sensory symptoms
Lower urinary tract dysfunction
Cerebellar and brain stem features
Cognitive impairment- in severe MS
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10
Q

What is pyramidal dysfunction?

A

Something affecting the corticospinal (pyramidal tract).
Causes weakness in the extensors of the arms and flexors of the legs.
Spasticity
Increased tone.

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11
Q

What is optic neuritis?

A

Painful visual loss due to inflammation at the optic nerve head.
They will have a relative afferent pupillary defect.
Lasts about 1-2 weeks.

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12
Q

What sensory systems are likely to show in MS?

A 
Pain
Paresthesia
Numbness
Dorsal column loss- loss of proprioception and vibration sense. 
Trigeminal neuralgia??
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13
Q

How would cerebellar dysfunction present in MS?

A 
Lack of co-ordination of movement. 
Ataxia
Dysdiadokinesis
Nystagmus
Intention tremor
Past pointing

(REMEMBER DANISH- D-dysdiadokinesis, A-ataxia, N-nystagmus, I-intention tremor, S-stacchato, H- hypotonia

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14
Q

How might brainstem dysfunction present in MS?

A 
Diplopia (cranial nerve VI palsy)
Facial weakness (cranial nerve VII palsy)
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15
Q

What is internuclear ophthalmoplegia?

A

When you try and use your lateral vision- e.g. looking right.
The right eye can abduct- so moves that way. However the left eye can’t adduct and therefore stays looking forwards. This causes the right eye to go into nystagmus. Issue is with the left eye- causes double vision.

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16
Q

What sort of lower urinary tract symptoms may someone with MS present with?

A

Same as old men with prostatic hypertrophy.

Frequency, urgency, nocturia, retention

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17
Q

How would you manage fatigue in an MS patient?

A

Amantadine
Modafinil if sleepy.
Hyperbaric oxygen.

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18
Q

What is the diagnostic criteria for MS?

A

2 separate occasions of focal neurological deficit. Most show dissemination in time and space.

19
Q

What are the possible differentials for a diagnosis of MS?

A

Vasculitis
Recurrent strokes?
Infection

20
Q

What investigations will allow you to diagnose MS?

A

Clinical- history
Imaging- MRI
Lumbar puncture
Blood tests

21
Q

Why would you do blood tests in MS?

A

There isn’t something you are looking for, you are just looking to rule out things like infection and vasculitis.

22
Q

What blood picture would you get if the patient was suffering from vasculitis?

A

CRP and plasma viscosity would probably be high.

23
Q

In infection, what would the blood picture look like?

A

Serology would show presence of infection e.g. Borrellia, HIV.

24
Q

On drawing CSF, what would you expect to find if a patient was suffering from MS?

A

Oligoclonal bands are present. These are immunoglobulins that are present when there is inflammation in the CNS

25
Q

How would you manage a mild acute exacerbation of MS?

A

Symptomatic relief.
If someone woke up to some tingling- then no treatment required. However if the tingling is unpleasant- offer symptomatic relief.

26
Q

How would you manage a moderate acute exacerbation of MS?

A

This could be difficulty walking. Give oral steroids.

27
Q

How would you manage a severe acute exacerbation of MS?

A

Admit them

Give IV steroids

28
Q

What can treat the pyramidal dysfunction?

A

Physiotherapy- to strengthen muscles
Occupational therapy- for splintage
Anti-spasmodic agents e.g. baclofen.

29
Q

What can treat the spasticity that patients experience?

A

Baclofen again
Or botox
However can cause floppiness/drowsiness.

30
Q

How would you treat sensory symptoms

A

Dampen down neurotransmission with anti-convulsants and anti-depressants e.g. gabapentin and amitryptilline
Could try tens machine
Acupuncture
Lignocaine infusion

31
Q

What treatment can you give for lower urinary tract symptoms?

A

Anti-cholinergics e.g. oxybutylin
Desmopressin
Catheterisation

32
Q

What treatment can you give for the fatigue?

A

Amantadine

Modafinil if sleepy.

33
Q

What is the first line therapy for MS (not in an acute exacerbation)?

A

Disease modifying therapy

  • Interferon beta- e.g. Avonex
  • Glitiramer acetate
  • Tecfidira
34
Q

What is the second line therapy for MS (not in an acute exacerbation)?

A

Monoclonal antibodies

Fingolomod

35
Q

What is the third line therapy for MS (not in an acute exacerbation)

A

Mitoxantrone

36
Q

How is avonex given?

A

Intra muscular injection once weekly.

37
Q

How is tecfidira given?

A

Tablet

38
Q

Describe interferon beta and capoxones effect?

A

Reduce the relapse rate and reduce severity of relapses.

39
Q

When should tecfidera be used?

A

Its the first line in relapsing remitting MS.

40
Q

What is the preferred second line from NICE?

A

Fingolomod

41
Q

When should monoclonal antibodies be used?

A

In highly active relapsing remitting MS- despite treatment with interferon.

42
Q

What is progressive multifocal leucoencephalopathy?

A

A rare disease of the white matter where inflammation and damage occurs in multiple lesions.

43
Q

What causes progressive multifocal leucoencephalopathy?

A

Infection by the JC virus.

All second line therapies can also cause this.

44
Q

What drug should be used in relapsing progressive MS?

A

Mitoxantrone

Neurology (19 decks)

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