Multiple Sclerosis

Question 1

Epidemiology of MS

Answer 1

-Young
-2F:1M
-1 in 500 Scotland

Question 2

What structures are involved in MS?

Answer 2

-Disease of the brain and spinal cord myelin
-Axons= oligodendrocytes provide metabolic support and saltatory conduction for underlying axon

Question 3

Why is myelin important?

Answer 3

-Development- increasing physical and mental skills, learning throughout life

Question 4

What causes MS?

Answer 4

-Genes (identical twins 30%)
-Immune system (latitude and vitamin D)
-Infections (EBV)

Question 5

Pathology of MS

Answer 5

-Demyelinating disease
-Inflammatory lesions

-Immune attack- T cells into brain- demyelination
=Oligodendrocyte precursor cells to remyelinate (nerve protection) but shorter and thinner than original

Question 6

MS disease course

Answer 6

-Alternating remission and relapsing course
-Inflammation then neurodegeneration
-LATER=less back to normal, progressive (worsens over time)
-If progressive proceeded by relapsing remitting MS called secondary progressive MS vs always getting worse primary progressive

Question 7

MS Investigations

Answer 7

-Routine blood tests (electrolyte imbalance)
-CT (tumour)
-MR brain (inflammation, periventricular plaques, Dawson’s fingers, lesions disseminated in time and space)
-CSF= oligoclonal bands, increased intrathecal synthesis of IgG
-Delayed visual evoked potentials

Question 8

Typical presentation of relapsing-remitting MS

Answer 8

-Gradual onset of central neurological problem (days)
-Numbness/ weakness down half of the body (hemiparesis) or both legs (paraparesis)
-Sensory= pins and needles, trigeminal neuralgia

-Blurred vision in one eye (optic neuritis- pale optic disk, optic atrophy)
-Uhthoff’s phenomenon= worsening vision following rise in body temperature
-Internuclear ophthalmoplegia
-Double vision

-Cerebellar syndrome: urinary incontinence, ataxia, tremor, sexual dysfunction, intellectual deterioration, transverse myelitis
-Fatigue/ lethargy

Question 9

Treatments for relapsing-remitting MS

Answer 9

30% reduction
-Beta-interferon
-Glatiramer acetate
-Teriflunomide

50% reduction
-Dimethylfumerate
-Fingolimod
-Cladribine

70% reduction
-Ocrelizumab
-Natalizumab
-Alemtuzumab
-Haematopoietic stem cell transplant

Question 10

Side effects of relapsing-remitting MS treatments

Answer 10

-Dimethylfumerate= some cases of PML (progressive multifocal leukocephalopathy very often fatal)
-Fingolimod= HSV encephalitis
-Natalizumab= PML
-Alemtuzumab= 2% of ITP, 30% thyroid disease
-Ocrelizumab= infection

Question 11

Role of stem cells in progressive MS

Answer 11

-Reduce immune attack?
-Ensure oligodendrocytes repair myelin quickly?
-Stops nerves dying back/ regrow nerves with correct connections?

-IPS person specific= compatibility/ disease lines
-Ethically easier
-How do we get them in?
-Can they migrate?
-How will they know what connections to make?

Question 12

Other pharmacological management of MS

Answer 12

-IV methylprednisolone in acute relapse
-Baclofen and gabapentin for spasticity