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Flashcards in MS and MND Deck (24):
1

Describe MS

Inflammatory plaques of demyelination in CNS occurring at multiple sites

2

Course of MS

Relapsing remitting
Attacks >30 days apart and >1hour duration
Over time remission becomes incomplete so progressive disability

3

Age of onset in MS and MND

MS: ~30 years
MND: >40 years

4

Common presentation of MS

Unilateral optic neuritis (pain on eye movement)
Corticospinal involvement
Urine retention or incontinence
Symptoms worsen with heat

5

Clinical features of MS (11 points)

Sensory loss
Trigeminal neuralgia
Spastic muscle weakness
Urine retention/incontinence
Constipation
Sexual dysfunction
Dysphagia
Diplopia
Optic neuritis
Cerebellar signs
Cognitive decline

6

Criteria for MS

McDonald

7

Diagnosis of MS

MRI sensitive for plaque detection (and excludes other causes)
LP for IgG detection

8

Effect of pregnancy on MS

During pregnancy relapses may reduce
After giving birth relapses may increase for 3-6 months
Frequency returns to previous rate

9

Management of MS

Lifestyle: exercise, stop smoking
Disease modifying drugs: dimethyl fumarate, monoclonal antibodies
Relapse drugs: methylprednisolone for 3-5 days
Symptom control

10

Treatment for spasticity

Baclofen
Gabapentin

11

Treatment for tremor in MS

Botulinum toxin injections

12

Management of urinary symptoms in MS

Self catheterisation if RV >100ml
Tolteridone if RV <100ml

13

Describe MND

Loss of neurones in:
Motor cortex
Cranial nerve nuclei
Anterior horn of spinal cord
(Mixed UMN and LMN signs)

No sensory loss
No sphincter disturbance

14

What are the 4 different clinical patterns of MND

ALS
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

15

What does ALS stand for

Amyotrophic lateral sclerosis

16

Describe ALS

Loss of motor neurones in motor cortex and anterior horn of spinal cord leading to UMN and LMN signs

17

Describe progressive bulbar palsy

LMN signs affecting cranial nerves 9-12
Results in difficulty talking and swallowing

18

Describe progressive muscular atrophy

Anterior horn cell lesion so LMN signs
Distal muscles affected earlier than proximal

19

Describe primary lateral sclerosis

Loss of neurones in motor cortex so UMN signs
Spastic leg weakness and pseudobulbar (damage to corticobulbar tracts)

20

Contrast bulbar and pseudobulbar palsy

Bulbar is LMN lesion of muscles of talking and swallowing, pseudobulbar is UMN lesion of muscles of talking and swallowing
Pseudobulbar has increased jaw jerk, slow speech and mood incongruence

21

What other progressive condition is associated with MND

Frontotemporal dementia in 25%

22

Diagnosis of MND

No diagnostic test,
MRI excludes structural causes
LP excludes inflammatory causes

23

Disease modifying drugs for MND

Riluzole - NMDA antagonist

24

Symptom management for MND

Salivation - antimuscurinics and auctioning
Dysphagia - blend food, gastrostomy
Spasticity - baclofen or gabapentin
Alternative communication equipment
Non invasive ventilation