MS

Question 1

What is the specific characteristic of the lesions that makes the diagnosis of MS?

Answer 1

The lesions must be disseminated in space and time

Question 2

Despite no known cause what are the risk factors for MS?

Answer 2

Affected family members and lack of sunlight exposure/vit D

Question 3

Raised risk due to lack of sunlight means that which areas are more affected?

Answer 3

Temperate counties while those by the equator have lower prevalence of MS

Question 4

What age and sex is it most common in?

Answer 4

Women (3:1)

30 years old

Question 5

Prevalence in normal population? (Per 100000)

Answer 5

42

Question 6

What are the chances of getting MS if you have an affected twin?

Answer 6

1/4

Question 7

What are the chances of developing MS if you have an affected sibling who isn’t a twin?

Answer 7

1/30

Question 8

Give the categories of symptoms that the patient may present with (E.g. Visual)…

Answer 8

Visual, eye movement, facial weakness, hearing and balance, cognitive, taste, psychological, sexual, unpleasant sensations, numbness, myelitis, autonomic and other

Question 9

What visual problems may occur?

Answer 9

Hemianopia, blindness

Often only affects one eye

Question 10

What eye movement problems may occur?

Answer 10

Nystagmus, double vision (diplopia cn 3,4,6 lesions)

Question 11

What facial movement issue might occur?

Answer 11

Bell’s palsy

Question 12

What hearing and balance symptoms may occur?

Answer 12

Deafness, unsteadiness, vertigo, vomiting, nausea

Question 13

What cognitive issues may occur?

Answer 13

Reduced visual and auditory attention, reduction of intellect

Question 14

Are psychological issues common?

Answer 14

No but depression often develops as the disease progresses

Question 15

What unpleasant sensations may occur?

Answer 15

Tightness, burning, tearing (due to damage to posterior column) Lhermittes sign (neck flexion causes electric shock sensation), loss of thermal sensation, tingling

Question 16

What occurs in transverse myelitis?

Answer 16

Episode of paralysis of both legs and sensation, loss of bowel and bladder control

Question 17

What autonomic issues may occur (includes sexual)…

Answer 17

Loss of thermoregulation (pyrexia, XS sweating), loss of bladder control, increased urinary frequency/urgency, erectile dysfunction

Question 18

Name 2 other features that may occur?

Answer 18

Horners syndrome
Weight loss
Arrythmias

Question 19

What criteria are used for diagnosing MS?

Answer 19

McDonald criteria

Question 20

What clinical evidence is enough to provide a diagnosis of MS?

Answer 20

2 or more attacks with 2 objective clinical lesions

Question 21

What is the problem with MRI?

Answer 21

It is highly sensitive but it is not specific

Question 22

What percentage of those who have an MS episode with a consistent MRI develop MS?

Answer 22

90%

Question 23

What are the three forms of MS?

Answer 23

Relapsing remitting, primary progressive, secondary progressive

Question 24

What is the ratio of relapsing-remitting to primary progressive?

Answer 24

85:15

Question 25

What percentage of those with relapsing remitting develop secondary progressive?

Answer 25

75%

Question 26

What other investigations can you do to back up your clinical diagnosis?

Answer 26

MRI, CSF, evoked potentials for auditory, visual and somatosensory senses (looking for delay)

Question 27

What might CSF electrophoresis testing show? What does this suggest?

Answer 27

Oligoclonal IgG bands which aren't present in serum. Suggests CNS inflammation

Question 28

What is the conservative management for MS?

Answer 28

Encourage reduction in stress, minimise disability, if there is poor diet or reduced sun exposure give vitamin D

Question 29

What is the management for relapse?

Answer 29

Give methylprendisalone IV for 3 days to shorten relapse

Question 30

What is the pharma management for reducing relapses?

Answer 30

Interferons or azathioprine , alemtuzumab/natalizumab, dimethyl fumurate (if two relapses in past year)

Question 31

How much does interferon beta/ azathioprine reduce relapse rate?

Answer 31

30%

Question 32

What percentage does natalizumab reduce relapse rate by? And no. Of MRI lesions?

Answer 32

68% | 92%

Question 33

What drugs are given for treating primary progressive MS?

Answer 33

There are no drugs that have shown significant effect in treating primary progressive

Question 34

When patients become progressive what is the focus of treatment?

Answer 34

Symptom relief for palliation

Question 35

What is MS?

Answer 35

T cells mediated demyelination of multiple CNS sites, which heals very poorly leading to relapsing and remitting symptoms. If demyelination occurs long enough there may be axonal loss and progressive symptoms.