Multiple Sclerosis

Question 1

What is MS?

Answer 1

Multiple sclerosis is chronic cell-mediated autoimmune disorder characterised by demyelination in the central nervous system.

Question 2

What gender is it more common in?

Answer 2

Women

3 times more common

Question 3

What age is it usually diagnosed in?

Answer 3

Aged 20-40 years

Question 4

What are the subtypes?

Answer 4

• Relapsing-Remitting Disease - most common form - 85% of patients.
  
  • Acute attacks (1-2 months) followed by remission
• Secondary Progressive Disease
• Primary progressive Disease

Question 5

What is Secondary progressive MS?

Answer 5

It describes relapsing-remitting patients who have deteriorated and developed neurological signs and symptoms between relapses.

Question 6

What % of Relapsing-Remitting sufferers go on to get secondary progressive MS?

Answer 6

Around 65% of R-R go on to get this.

Question 7

What neurological features are most common in secondary progressive disease?

Answer 7

Gait and Bladder disorders

Question 8

In what group of people is primary progresive disease more common in?

Answer 8

Older patients

Question 9

What visual symptoms do MS patients get?

Answer 9

• Optic neuritis: common presenting feature
• Optic atrophy
• Uhthoff’s phenomenon: worsening of vision following rise in body temperature
• Internuclear ophthalmoplegia

Question 10

What sensory symptoms can they get?

Answer 10

• Pins/needles
• Numbness
• Trigeminal neuralgia
• Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion

Question 11

What motor symptom is most commonly seen in MS?

Answer 11

Spasticity of the legs

Question 12

What cerebellar features are most commonly seen?

Answer 12

Ataxia and tremor

Question 13

What are some other features of MS?

Answer 13

• Urinary incontinence
• Sexual dysfunction
• Intellectual deterioration

Question 14

What are some good prognostic features in MS?

Answer 14

REMEMBER: Typical Patient > Atypical patient

• Female sex
• Young age of onset (i.e. 20s or 30s)
• Relapsing-remitting disease
• Sensory symptoms only
• Long interval between first two relapses
• Complete recovery between relapses

Question 15

How are acute relapses managed?

Answer 15

High dose steroids given for ~5 days.

Question 16

What treatment can be used for fatigue?

Answer 16

• Investigate for other problems (depression, thyroid, anaemia)
• Trial of Amantadine
• Mindfulness training or CBT

Question 17

What is the treatment for spasticity?

Answer 17

Baclofen and gabapentin are first line

Question 18

What is the treatment for oscillopsia (Visual fields appear to oscillate)

Answer 18

Gabapentin is first line

Question 19

How do you manage bladder dysfunction?

Answer 19

• May take the form of urgency, incontinence, overflow etc
• Guidelines stress the importance of getting an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients
• If significant residual volume → intermittent self-catheterisation
• If no significant residual volume → anticholinergics may improve urinary frequency