MS: Clinical Features & Management

Question 1

https://doi.org/10.1038/nrneurol.2016.187

Answer 1

• Risk factors: EBV, vitamin D, smoking, obesity, latitude
• Genetic factors: HLA, SNPs
• Increase in MS amongst women
• Smoking is also associated with resistance to drug therapy
• Gene environment interaction: effect of smoking depends on HLA genotype
• Potential protective effect of CMV
• Increased UV exposure linked to decreased risk of MS, linked with vit D importance
• Shift work - increases risk of MS especially in young people
• Alcohol: inverse association?
• Coffee: inverse association?
• Dietary salt linked with more relapses

Question 2

DOI: 10.1038/s41582-018-0082-z

Answer 2

• Injectable drugs were the first to be developed
• Now some drugs are still injectable, injected fortnightly
• Monoclonal antibodies (the first natalizumab) thouhg there is increased risk
• Fingomyloid was the first oral drug, prevents T cells from leaving secondary lymph organs
• New monoclonal antibodies: alemtuzumab

Question 3

What is MS?

Answer 3

Chronic inflammatory multifocal, demyelinating disease of the CNS resulting in loss of myelin and oligodendroglial and axonal pathology

Question 4

Describe prevalence of MS in the UK

Answer 4

131,720

Question 5

Describe MS prognosis

Answer 5

Life expectancy reduced by 7-14 years, for most disease duration is 40-50 years

Question 6

Describe social impact of MS

Answer 6

• Low probability of remaining in active employment

- Less likely to remain in a relationship after MS onset

Question 7

Describe early cognitive impairment in MS

Answer 7

• Memory
• Speed of information processing
• Attention
• Executive functioning

Question 8

Describe the relationship between MS and hormones

Answer 8

• Acute attacks decrease during pregnancy and then sharply increase straight after delivery

Question 9

List differentials for MS

Answer 9

• Neuromyelitis optica: Optic neuritis and transverse myelitis
• Acute disseminated encephalomyelitis

Question 10

Describe management of acute attacks

Answer 10

• Exclude pseudorelapses (heat or fever related)

- Decide on necessity of treatments

Question 11

Describe importance of disease modifying treatments in MS

Answer 11

• Suppress relapses, and prevent disability progression
• Prevent conversion to secondary progressive MS
• Prevent new white matter lesions and reduce the rate of brain atrophy