multiple sclerosis

Question 1

definition of multiple sclerosis?

Answer 1

disease of unknown origin in which there is multiple areas of demyelination of cns and spinal cord occur peak age is 20-40 women affected twice as men.

Question 2

etiology?

Answer 2

autoimmunity, because there is increase number of t lymphocytes in the CSF and immunoglobin.
Associate with HLA-DR2

Question 3

what is MRI plaques of demyelination?

Answer 3

inflammed myeline sheath with fibrosis

Question 4

common sites of demyelination?

Answer 4

periventricular spaces, brainstem and its cerebellar connections, optic nerve, cervical spinal cord

Question 5

clinical features?

Answer 5

optic neuritis repeated attack cause optic atrophy, weakness in one or more limb, hyperreflexia, hypertonia, extensor planter reflex, absence of abdominal reflex show pyramidal tract disease, paresthesia,ataxia, diplopa urinary and fecal incontinence, urgency in advance disease
Bilateral trigeminal neualgia
Lhermitte’s sign: electrical sensation pass down back when neck flexed

Question 6

types of MS?

Answer 6

relapsing remitting
secondary progressive
primary progressive
end stage MS

Question 7

features of end stage disease?

Answer 7

spastic paraparesis, ataxia, optic atrophy, nystagmus, pseudobulbar palsy, incontinence, death due to bronchopneumonia and renal failure

Question 8

prognostic factors?

Answer 8

good: onset before 40, relapsing remitting type, visual sensory symptoms alon
bad: truncal ataxia, severe action tremor, primary progressive disease

Question 9

investigation?

Answer 9

csf examination shows: increase lymphocytes more than 50 cells/L,IgG icreased(csf protien), two or more oligoclonal bands(csf electrophoresis) but it is not specific
MRI(gold standard) shows plaque and it is very sensitive
visual evoked potential and brainstem auditary evoked potential
routine test like blood cp, chest xray, eeg, urine analysis,

Question 10

D/D?

Answer 10

stroke( more sudden than MS)
SLE
friedreich ataxia remission not occur
cns sarcoidosis
behcet syndrome but it has oral and genital lesion and uveitis

Question 11

treatment?

Answer 11

disease modifying include in acute and initial stage:
iv methlyprednislone 3 days 250mg with 250 dextrose then oral steroid for 18 days
prophylaxis for relapse: interferon 1a 1b I/M S/C once week or every other day respectively
for secondary remission: methotrexate, azathioprine, cyclophosphamide

Question 12

supportive therapy?

Answer 12

physiotherapy
baclofen(spasticity)
diazepam
clonazepam
dantrolene
for painful paresthesias: carbamazpine, amitriptyline
for ataxia: clonazepam,isoniazid
for urinary urgency: anticholinergic drug(imipramine)
urinary retention: cholinergic drug bethanecol
constipation: laxative