MS Flashcards
What is Multiple sclerosis?
Acquired chronic immune-mediated inflammatory condition of the CNS - affecting both the brain and spinal cord
Believed abnormal immune response to environmental trigger
Demyelination of the myelin sheath causing plaques which disrupt the neural pathway
How does MS present?
- late 20s
- visual disturbance, painful eye movements, double vision
- ascending sensory disturbance
- limb weakness
- gait problems
- problems with balance
- dysphagia
- bladder/bowel symptoms (detrusor over/under activity)
- cognitive impairment
Outline the 3 main patterns of MS
Relapsing-remitting = most common, repeated neurological relapses, followed by complete/partial recovery, can devel into sec progressive
Primary progressive = symptoms gradually devel, worsen over time without recovery
Secondary progressive = gradual progression, unrelated to relapses after an initial relapsing-remitting course
How should MS be investigated?
CSF = oligoclonal bands of IgG
MRI = demyelinating plaques
How is a Dx made?
2010 McDonald criteria =
- ep are consistent with inflam process
- excluding alternative dx
- establishing lesions have devel at diff times and are in diff locations
- establish progressive deterioration over 1y
How is an acute relapse of MS Mx?
Rule out infection, tx if present
IV methyprednisolone and plasma exchange
How is MS generally Mx?
Spasticity = physio, baclofen
Neuropathic pain = gabapentin, pregabalin, carbamazepine
Depression = CBT, citalopram (SSRI)
Incontinence = oxybutynin, botulinum toxin
Swallowing disorders = good posture, eat slowly, chew well, alternative liquid/solid, don’t speak, thickeners
Emotional lability = amitryptiline
Fatigue = lifestyle modification (exercise, good sleep), amantadine
How does pregnancy effect MS?
Doesn’t effect fertility
MDT = Copaxone
Is a positive protective influence, with relapse rates going down, especially during 3rd trimester (between 6-9m)
First 3m after the baby is born, your risk of relapse rises
Having MS will not directly affect the pregnancy, labour or giving birth
Most DMTs shouldn’t be taken if you want to breastfeed
What are the indication for the use of beta-interferon as a DMT?
(anti-inflam)
Relapsing MS and a recent relapse and/or if MRI scans show new signs that the MS is active (new lesions)
Secondary progressive MS but still have significant relapses
‘clinically isolated syndrome’ or CIS (a first attack of MS-like symptoms) and a brain scan shows you’re likely to go on to get MS
List some common DMT used in MS and important side effects
Interferon beta = injection site reactions, flu-like sx, headache, myalgia, nausea, pain, fever
1-a glatiramer acetate = immediate post injection reaction, N+V, chills, athralgia, neck/back pain
1-b glatiramer acetate = immediate post injection reaction, N+V, chills, athralgia, neck/back pain
Mitoxantrone = N+V, heartburn, stomach pain, diarrhoea, constipation, headache
Natalizumab = dizziness, nausea, urticaria, shivering
