3: Multiple sclerosis

Question 1

What is multiple sclerosis?

Answer 1

Inflammatory demyelinating disease of the CNS

Question 2

Multiple sclerosis is more common in (men / women).

Answer 2

women

3:1

Question 3

At what age do people tend to develop multiple sclerosis?

Answer 3

30s - 40s

Question 4

Multiple sclerosis is an ___ disease.

Answer 4

autoimmune

Question 5

What does “disseminated in time and place” mean in relation to multiple sclerosis?

Answer 5

Lesions have to have developed

in different areas of the CNS

at different times

Question 6

What is pyramidal dysfunction?

Answer 6

Problems affecting the pyramidal tracts i.e the corticospinal tract and corticobulbar tract

Question 7

What do the

a) corticospinal tract
b) corticobulbar tract

control?

Answer 7

a) Voluntary movement

b) Movement re: cranial nerves

Question 8

Pyramidal dysfunction causes (motor / sensory) symptoms.

Answer 8

motor symptoms

Question 9

What are some examples of pyramidal dysfunction caused by multiple sclerosis?

Answer 9

Increased muscle tone

Muscle spasm

Weakness

Tremor

Question 10

What is optic neuritis?

Answer 10

Inflammation of the optic nerve

Question 11

What eye problems are caused by multiple sclerosis?

Answer 11

Optic neuritis (inflammation of optic nerve)

Nystagmus

Diplopia

Question 12

What is the main complaint of optic neuritis?

Answer 12

Painful visual loss

Question 13

What sign will you see on examination of the eyes of a patient with optic neuritis?

Answer 13

Relative afferent pupillary defect

swinging light test

Question 14

What sensory symptoms do patients with multiple sclerosis complain of?

Answer 14

Pain

Tingling (paraesthesia)

Numbness

Question 15

People with multiple sclerosis may lose their sense of proprioception and vibration.

Which sensory pathway is responsible for these?

Answer 15

DC/ML pathway

Question 16

Which nerve is affected if a patient with MS complains of facial pain?

Answer 16

Trigeminal nerve (CN V)

Question 17

Which part of the brain, controlling coordination, is affected in MS?

Answer 17

Cerebellum

Question 18

MS causes cerebellar symptoms.

What is Charcot’s triad of MS?

Answer 18

Dysarthria (slurred speech)

Tremor

Nystagmus

Question 19

Which cranial nerves are affected if an MS patient complains of

a) diplopia
b) facial weakness?

Answer 19

a) CN III, IV or VI
b) CN VII

Question 20

Patients with MS will complain of constant ___.

Answer 20

fatigue

Question 21

Which investigations are used to diagnose MS?

Answer 21

Neuro exam

MRI scan (to pick up lesions)

Lumbar puncture (to examine CSF)

Blood tests (for autoantibodies and to rule out other diseases)

Question 22

What are the Mcdonald criteria for diagnosing MS?

Answer 22

TWO episodes of symptoms suggesting demyelination

“Dissemination in time and place”

Question 23

Why is the CSF examined in patients with suspected MS?

Answer 23

‘Oligoclonal bands’ in the CSF is highly predictive of MS

Question 24

MS can ___ causing acute exacerbations.

Answer 24

flare

Question 25

How are **mild** exacerbations of MS treated?

Answer 25

Symptomatic treatment --- **Baclofen and physio referral for motor symptoms** **Gabapentin and amitriptyline for neuropathic pain**

Question 26

Why aren't normal analgesics e.g paracetamol used in the symptom management of MS?

Answer 26

**Not effective for neuropathic pain**

Question 27

How are **moderate** exacerbations of MS treated?

Answer 27

**Oral steroids** Immunosuppressant remember

Question 28

How are **severe exacerbations** of MS treated?

Answer 28

**Admission to hospital** **IV steroids**

Question 29

Which **anti-spasmodic drug** is used to relieve motor symptoms of MS?

Answer 29

**Baclofen**

Question 30

Which AHPs are involved in the management of motor symptoms of MS?

Answer 30

**Physiotherapist** **Occupational therapist**

Question 31

Which drugs are used to manage the **sensory symptoms of MS**?

Answer 31

**Gabapentin** **Amitriptyline**

Question 32

Which **class** of drug is used to treat urge incontinence caused by **MS?** Name an example?

Answer 32

**Antimuscarinic** Oxybutynin, Tolterodine

Question 33

Which illegal drug has been proven to give symptomatic relief in MS?

Answer 33

**Cannabis**

Question 34

Which drugs are used to help control a) motor b) sensory symptoms of MS?

Answer 34

**a) Baclofen** (muscle relaxant) **b) Gabapentin** (anticonvulsant), **amitriptyline** (antidepressant)

Question 35

Does symptomatic treatment halt the progress of MS?

Answer 35

**No**

Question 36

MS progresses in (the same way / different ways) in individual patients.

Answer 36

**different ways**

Question 37

Which **three immunosuppressants** can be used first-line in the treatment of MS?

Answer 37

**Interferon beta** **Copaxone** **Tecfidera** just memorise this like the MSK one