Multiple Sclerosis

Question 1

what is MS

Answer 1

chronic and progressive inflammatory demyelination of neutrons

can affect different parts of the brain/ SC causing different presentations

Question 2

what is the mechanism/ pathology of multiple sclerosis

Answer 2

Infiltration of immune cells on the neurones of the CNS (oligodendrocytes)

doesn’t typically affect peripheral NS neurones (Schwann cells)

these immune cells attack myelin leading to symptoms

re-myelination occurs but doesn’t heal well

lesions are disseminated in time and space

Question 3

what are the 2 groups of MS patients

Answer 3

Relapsing-remitting= makes up 80% of patients

this can become secondarily progressive

Primary progressive= makes up <10%

remaining 10% are difficult to classify

Question 4

who gets MS

Answer 4

F>M

mean onset 30yrs

northern latitudes

Question 5

what are the risk factors for MS

Answer 5

Female Gender
Family History
Auto-immunity
EBV infection

Question 6

how does MS present and how does this differ in the two types

Answer 6

Relapsing-remitting= episodic flare up separated by periods of remission. most will then become secondary progressive in 15 years

primary progressive= symptoms get worse from disease onset (usually affects older patients)

typical presentation=
sensory loss
muscle cramping
bladder, bowel and sexual dysfunction
cerebellar symptoms e.g. nystagmus
pain

Question 7

how do you diagnose MS

Answer 7

clinical history/ exam

imaging (periventricular white matter lesions on MRI scan)

oligoclonal bands in CSF (LP)

McDonald Criteria

Question 8

how do you manage acute attacks of MS

Answer 8

IV methylprednisolone

gabapentin if in neuropathic pain

Question 9

how do you manage MS chronically

Answer 9

Disease Modifying Treatments (not a cure but reduced relapses)

symptomatic therapy e.g. gabapentin

baclofen for spasticity

anticholinergics for bladder dysfunction

Methylprednisolone to induce longer term remissions