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pre reg afsha > CNS - MS > Flashcards

CNS - MS Flashcards

1
Q

What is MS and what does it affect

A

Chronic, immune mediated, demyelinating inflammatory condition of the CNS
Affects brain, optic nerves, spinal cord
Leads to progressive severe disability

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2
Q

Relapsing-remitting MS (RRMS)

A
  • Most common pattern of the disease
  • Characterised by periods of relapses (exacerbations of symptoms) followed by remission (unpredictable periods of stability)
  • Severity and frequency of relapses varies greatly between patients
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3
Q

Relapsing-remitting MS: disease activity of ACTIVE

A

ACTIVE if at least two clinically significant relapses occur within the last 2 years

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4
Q

Relapsing-remitting MS: disease activity of HIGHLY ACTIVE

A

HIGHLY ACTIVE when there is an unchanged/increased relapse rate, or ongoing severe relapses compared with the previous year, despite disease-modifying drug treatment

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5
Q

Relapsing-remitting MS: disease activity of RAPIDLY EVOLVING SEVERE RELAPSING REMITING MS

A

RAPIDLY EVOLVING SEVERE RELAPSING REMITING MS is defined by two or more disabling relapses in 1 year, and one or more gadolinium-enhancing lesions on brain MRI or a significant increase in T2 lesion load compared with a previous MRI

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6
Q

What does the clinical pattern of relapsing remitting MS often develop into

A

secondary progression MS, with progressive disability unrelated to relapses

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7
Q

What is primary progressive MS

A
  • Follows a gradual course, with the development of symptoms that worsen over time without relapses and remissions
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8
Q

What is progressive-relapsing MS

A
  • Follows a course of steadily worsening neurological function from onset, plus acute relapses
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9
Q

Is there a cure to MS

A

No

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10
Q

Treatment aims

A
  • modify the course of the disease and manage symptoms in order to improve QoL
  • reducing frequency + duration of relapses and preventing or slowing disability
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11
Q

Vitamin D and MS link

A
  • Low levels of vit D believed to be a RF for developing MS
    • Pt with MS usually given regular vit D after assessment of their serum levels of vit D, but there is insufficient evidence to support its use as a treatment for MS
    • Do not offer vit D to pt solely for the purpose of treating MS
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12
Q

Type of disease modifying drugs that can be used under specialist care for RRMS

A

○ Anti-lymphocyte mabs
○ Antimetabolites
○ Immunomodulators
○ Immunostimulants
○ Interferons

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13
Q

Type of disease modifying drugs that may be used under specialist care for secondary progressive MS

A

○ Immunomodulators
○ Interferons

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14
Q

Treatment for progressive-relapsing MS

A
  • No specific treatment options for this type of MS
    • None of the currently licensed disease-modifying drugs are recommended in non-relapsing progressive disease
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15
Q

Treatment options for primary progressive MS under specialist care

A

Anti-lymphocyte mabs

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16
Q

Smoking and MS

A

Smoking increases progression of disability in MS - encourage smoking cessation

17
Q

Complications of MS

A
  • Other than episodes of neurological dysfunction, chronic symptoms and complications produce much of the disability in MS
  • The complications include
    ○ Fatigue
    ○ Spasticity
    ○ Visual
    ○ Cognitive and memory problems
    ○ Bladder disorders
    ○ Pain
    ○ Emotional lability
    ○ Depression
    ○ Anxiety
18
Q

What to do if a patient relapses (including 1st line drug treatment)

A
  • Pt with suspected relapses should be referred to a specialist for diagnosis and treatment
  • CCs are recommended for reducing inflammation and accelerating recovery in acute relapses of RRMS
  • 1st line: oral methylprednisolone
    ○ Consider IV if oral has failed, not tolerated, or if hospitalisation required
19
Q

How to manage fatigue and impaired mobility - non drug treatment

A
  • Personalised support should be offered to help pt with MS and fatigue
  • Regular exercise should be encouraged - may have beneficial effects of mobility and fatigue
  • Cognitive behavioural techniques and mindfulness for fatigue, stress management, and well-being should be considered in combination with exercise
20
Q

How to manage fatigue and impaired mobility - drug treatment

A
  • For pt who wish to try drug treatment for fatigue (specialist initiation), the following may be used to treat fatigue related to MS
    ○ Amantadine (unlicensed use)
    ○ SSRI (unlicensed use)
    ○ Modafinil (unlicensed use)
  • Fampridine: licensed for improvement of walking in pt with MS who have a walking disability
    ○ NICE do not consider it to be cost-effective treatment; do not recommend its use
21
Q

Are vitamin b12 injections for treatment of fatigue suitable?

A

NOT recommended as a treatment for fatigue in pt with MS

22
Q

Factors that may aggravate spasticity

A

○ Infection
○ Bladder and bowel dysfunction
○ Poor posture or positioning
○ Pressure ulcers
○ Pain

23
Q

Management of spasticity

A
  • Manage any causes/factors that aggravate it (e.g. infection, pain, bladder and bowel dysfunction, pressure ulcers, poor posture)
  • 1st line for managing spasticity in MS: baclofen
  • If ineffective or not tolerated, 2nd line is gabapentin (unlicensed use)
  • Both drugs may be used cautiously in combination if individual drug ineffective or if SE prevent increase in dose of either drug
24
Q

Cannabis extract for spasticity

A
  • 4 week trial of cannabis extract can be offered as adjunct for moderate to severe spasticity in MS if other pharmacological treatments not effective
    ○ To be initiated and supervised by a specialist
25
Q

What is oscillopsia and how is it managed

A
  • Vision problem in which still objects seem to jump or vibrate due to misalignment of eyes or systems controlling balance
  • 1st line gabapentin unlicensed use
  • 2nd line memantine unlicensed use
26
Q

What is emotional lability and how is it managed

A
  • Refers to rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur
  • Amitriptyline, unlicensed use
27
Q
A

pre reg afsha (60 decks)

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