MS Flashcards
Define MS
An idiopathic inflammatory demyelinating disease of the CNS disseminated in space and time.
What is the pathophysiology of MS?
Acute episodes of inflammation lead to focal neurological deficits. Demyelination leads to progressive loss of neurological function.
Deficits only last about 24 hours and then improve. However, demyelination heals poorly and causes axonal loss and progressive disability.
What is the typical presentation of MS?
Optic neuritis - painful visual loss over a few days.
Trasverse myelitis - spinal cord inflammation which can present as incontinence, ED, anorgasmia.
Clinically isolated syndromes
What is the diagnostic criteria for MS?
> 2 episodes of demyelination disseminated in time and space. Attacks should last <1 hour, with > 30 days between attacks.
What are thought to be causes of MS?
Lack of vitamin D/sunlight
Viral e.g. EBV
Smoking
What investigations should be done in MS?
MRI brain and cervical spine - shows plaques of demyelination in >2 regions, enhancing and non-enhancing e.g . new and old.
LP - oligoclonal bands in CSF. Can also be increased WCC.
VERS - measures nerve conduction in optic nerve looking for optic neuritis.
What is an MS relapse?
A new neurological deficit lasting >24 hours without pyrexia or infection.
How is MS relapse treated?
IV methylprednisolone.
Can also give oral with PPI
What are treatments for relapsing remitting MS?
1st line:
- beta interferons and glatiramer acetate (decrease relapse frequency) IV
- dimethyl fumarate: suppress immune system. Oral.
- teriflunomide: same. Oral.
2nd line:
- fingolimod
- natalizumab: can cause PML in JC +ve
3rd line
- alemtuzumab: powerful, once a year. Can be used initially in aggressive.
What are important MS differentials?
Lyme disesae
Sarcoidosis
B12 deficiency
PML; do JC test (can’t be given stronger DMTS)
How is progressive MS treated?
Symptom management.
- Anti-cholinergics
- treat fatigue
- treat spasticity e.g. baclofen, gabapentin.
Biotin can help with symptom management.
