MS

Question 1

What is the pathophysiology of MS?

Answer 1

Demyelination of the white matter of the CNS caused by an autoimmune, T cell mediated response.
Causes still unknown

Question 2

What is specific about the symptoms in MS?

Answer 2

Disseminated in time and space

i.e. separate episodes which improve

Question 3

What is the most common type of MS?

Answer 3

Relapsing-remitting

Question 4

List the different types of MS:

Answer 4

Relapsing-remitting
Secondary Progressive
Primary Progressive

Question 5

What occurs in optic neuritis?

Answer 5

Usually unilateral
Colour changes
Visual field changes - central scotoma
Lasts usually 1 - 2 weeks

Question 6

What medication is given in acute phases to improve symptoms?

Answer 6

IV (or oral) steroids

Mehtylprednisalone

Question 7

List some of the symptoms associated with brainstem demyelination

Answer 7

Diplopia
Vertigo (without tinnitus/hearing loss)
Facial weakness

Question 8

Pyramidal Signs occur when there is a demyelinating plaque where?

Answer 8

The corticospinal tract

Question 9

List some pyramidal symptoms:

Answer 9

Increased tone
Spasticity
Weakness
Hyperreflexia

Question 10

Loss of proprioception is caused by a plaque where?

Answer 10

Dorsal column spinal tract

Question 11

List some other symptoms common in MS:

Answer 11

Fatigue
Water trickling sensation
Neuropathic pain
Urinary problems 
Sexual dysfunction
Depression / low mood
Temperature sensitivity

Question 12

Should exercise be recommended in patients with MS?

Answer 12

Exercising in swimming pool is best - prevents risk of overheating which can exacerbate symptoms

Question 13

List some signs/symptoms which suggest plaques in the cerebellum:

Answer 13

Ataxia
Intention tremor
Nystagmus
Past pointing
Pendular reflexes​
Dysdiadokinesis​
Dysarthria​

Question 14

What investigations should be done for MS?

Answer 14

Mostly diagnosis made on clinical history
Bloods done to rule out other differentials
MRI - will show plaques

Question 15

What drug is used to manage fatigue in MS and what is its mechanism of action?

Answer 15

Amantadine Hydrochloride

A weak dopamine agonist

Question 16

What else can amantadine hydrochloride be used to treat?

Answer 16

Parkinson’s

Question 17

What disease modifying drugs are first line in RRMS

Answer 17

Beta interferon
Alemtuzumab
Glatiramer acetate
Tecfidera

Question 18

What medication can be used to manage spasticity symptoms

Answer 18

Baclofen
Tizanidine
Botulinum toxin

Question 19

What medications can be used to manage the sensory symptoms?

Answer 19

Gabapentin
Amitriptyline
Lignocaine infusion

Question 20

What medications can be given to treat bladder / Urinary tract dysfunction

Answer 20

Oxybutynin

Desmopressin

Question 21

What is the second line dmd used in MS?

Answer 21

Monoclonal Antibodies
e.g. Tysabri, Lemtrada, Zymbrata​
OR
Fingolimod

Question 22

What disease modifying drug is third line in MS?

Answer 22

Mitoxantrone

Question 23

How would plaques of demyelination show up on an MRI?

Answer 23

Hyperintense regions

Question 24

What areas in the brain are most commonly affected by plaques?

Answer 24

Lateral ventricles
Corpus callosum
Optic nerves & chiasm
Brainstem
Cerebellum
Spinal cord and tracts

Question 25

What morphology is seen in active plaques?

Answer 25

Perivascular inflammatory cells Microglia Ongoing demyelination

Question 26

What morphology would be indicative of an inactive plaque?

Answer 26

Gliosis & scarring Little remaining myelinating axons Decreased number of oligodendrocytes and axons