Multiple Sclerosis

Question 1

Define MS

Answer 1

Inflammatory condition affecting myelin and oligodendrocytes of the cns. Peripheral nerves are NOT affected
?Autoimmune destruction of myelin with axons, loss
Unique macrophages that are able to cross blood-brain-barrier

Question 2

What patterns of disease progression exist?

Answer 2

80% are relapsing-remitting; these will often go on to secondary progressive
10%primary progressive
10% benign - one acute episode without further deterioration (problem is have to wait 10-15years before know for sure

Question 3

Common clinical signs in MS?

Answer 3

Sensory change - numbness , paraesthesiae

Eye changes: Optic neuropathy, INO, optic disc swelling, RAPD

Cerebellar: vertigo/ataxia

Autonomic defects - urinary incontinence etc
FATIGUE

Lhermitte sign - electric shock on voluntary neck flexing
Uthoff phenomenon - signs worse on hot day after exercise

Question 4

Investigations?

Answer 4

MRI with gadolinium (? Renal problems?)

Visual evoked potentials (EEG response to visual stimuli

Oligoclonal bands in CSF. Sensitive but nt specific

Question 5

Diagnosis of MS

Answer 5

At least 1 attack
\+
Multiple plaques in MRI 
OR
Single attack/ progressive disease MS
Multiple plaques
Other evidence e.g. VEPs or oligoclonal bands

Question 6

Management of acute attack

Answer 6

Short course of steroids

E.g. 3 days methylprednisolone; no more than 2 courses a year

No effect on long term outcome

Question 7

Chronic management to prevent relapses?

Answer 7

Prevent relapse and manage disability

Beta-interferon - reduces relapse rate and occurrence of plaques on MRI
!!!! NO effect in long term outcome

Glatiramer acetate - given IV can reduce number of relapses. It again no effect on long term outcome

Other|: mitoxantrone, natalizumab, baclofen

Question 8

Principles of management of chronic ms?

Answer 8

Prevent relapses

Reduce disability

Question 9

Rehabilitation and disability reduction?

Answer 9

Treat all infections promptly, ESP UTIs

? Self-catheterise or oxybutynin if residual urinary volume

Physiotherapy - reducing pain in spasticity

Cannabis based products for symptom relief

Prevent pressure sores

Question 10

What can mimic MRI lesions seen?

Answer 10

Sarcoidosis

SLE

Behcets

Question 11

Features of end-stage multiple sclerosis

Answer 11

Spastic tetra paresis

Ataxia

Optic atophy

Brainstem signs

Psuedobulbar palsy - bilateral damage; disease of corticobulbar tracts

Urinary incontinence

Dementia