Multiple Sclerosis

Question 1

Pathophysiology of MS

Answer 1

Typically only affects the CNS where there is inflammation around myelin and infiltration of immune cells that cause damage to the myelin

Question 2

Causes of MS

Answer 2

Genes, EBV, low vit D, smoking, obesity

Question 3

Diagnosis of MS

Answer 3

Based on clinical picture and symptoms suggesting lesions that change location over time Other causes need to be excluded

Question 4

Investigations supporing diagnosis

Answer 4

MRI scans to demonstrate typical lesions, LP to detect oligoclonal bands in CSF

Question 5

How long do symptoms need to progress for a diagnosis of primary progressive MS

Answer 5

1 year

Question 6

Focal weakness symptoms in MS

Answer 6

Bells palsy, Horner’s syndrome, limb paralysis, incontinence

Question 7

Focal sensory symptoms in MS

Answer 7

Trigeminal neuralgia, numbness, paraesthesia, Lhermitte’s sign

Question 8

Two different types of ataxia in MS

Answer 8

Sensory or cerebellar

Question 9

What causes cerebellar ataxia

Answer 9

Problems with the cerebellum coordinating movement

Question 10

What causes sensory ataxia

Answer 10

Result of loss of the proprioception sense

Question 11

What are the lesions seen on MRI scans of MS patients

Answer 11

periventricular white matter lesions

Question 12

Management of acute attack of MS

Answer 12

Glucocorticoids, rule out infection first

Question 13

Chrnic management of MS

Answer 13

Disease modifying therapies and symptomatic therapies

Question 14

First line injectable DMTs

Answer 14

Beta interferon injections and glatiramer acetate

Question 15

Oral agents used in MS

Answer 15

Dimethyl fumarate, Teriflunomide, Fingolimod, Siponimod, Cladribine

Question 16

Biologic agents used in MS

Answer 16

Natalizumab, Alemtuzumab, Ocrelizumab

Question 17

What is the role of dimethyl fumarate

Answer 17

Anti inflammatory, neuroprotective and anti-oxidative stress

Question 18

Side effects of dimethyl fumarate

Answer 18

GI upset and flushing

Question 19

Role of Teriflunomide

Answer 19

Immunomodulatory drug

Question 20

Role of Fingolimod

Answer 20

Immunosuppressive, used in more extreme forms to reduce relapses

Question 21

Side effects of Teriflunomide

Answer 21

Nausea, diarrhoea, hair loss and increased ALT

Question 22

Side effects of Fingolimod

Answer 22

Bradycardia, macular oedema and heart block

Question 23

Role of Siponimod

Answer 23

Immunosuppressive but does not act on cardiac receptors. USed in secondary progressive MS

Question 24

Role of Cladribrine

Answer 24

Immunosuppressive and anti lymphoproliferative. Given in highly acting relapsing remittingMS

Question 25

Side effects of Cladribrine

Answer 25

Infections, alopecia, lymphpenia

Question 26

Role of Natalizumab

Answer 26

Immunosuppressive. Relapsing remitting use. Monthly brain infusion

Question 27

Side effect of Natalizumab

Answer 27

Progressive multifocal leukoencaphalopathy

Question 28

Role of Alemtuzumab

Answer 28

Immunosuppressive. Given once or twice for breakthrough disease during treatment

Question 29

Role of Ocrelizumab

Answer 29

Immunosuppressive, option for relapsing remitting in adults with active MS

Question 30

Treatment for spasticity

Answer 30

Backofen and botox

Question 31

Treatment for fatigue

Answer 31

Modafenil and exercise

Question 32

Treatment for bladder dysfunction

Answer 32

Antocholinergics

Question 33

Treatment for tremor

Answer 33

Clonazepam

Question 34

Spectrums of MS

Answer 34

Clinically isolated syndrome, relapsing-remitting, secondary progressive, primary progressive

Question 35

What is the Clinically isolated syndrome of MS

Answer 35

First episode of demyelination and neurological signs and symptoms. May never go on to have another episode

Question 36

What is relapsing remitting MS

Answer 36

Characterised by epsidoes of disease and neurological symptoms, followed by recovery. Symptoms occur in different areas with different episodes

Question 37

Most common type of MS at diagnosis

Answer 37

Relapsing remitting

Question 38

Classifications of relapsing remitting MS

Answer 38

Active or worsening, not active or not worsening

Question 39

What is active vs not active relapsing remitting MS

Answer 39

New symptoms are or are not developing / lesions are appearing or not developing on MRI

Question 40

What is worsening vs not worsening relapsing remitting MS

Answer 40

There is an overall worsening in disability over time or no worsening in disability

Question 41

What is secondary progressive MS

Answer 41

There was relapsing remitting MS at first, but now there is a progressive worsening of symptoms with incomplete remissions.

Question 42

Classifications of secondary progressive MS

Answer 42

Active / not active and progressing / not progressing

Question 43

What is primary progressive MS

Answer 43

Worsening of disease and neurological symptoms from point of diagnosis without initial relapses and remissions.