Multiple sclerosis

Question 1

Define Multiple sclerosis

Answer 1

Autoimmune condition of the CNS, repeated episodes of inflammation leading to multiple plaques/loss of the myelin sheath
Sclerosis of nerves causes slowing of transmission

Question 2

What are the three main patterns of MS?

Answer 2

Relapsing remitting - symptoms come and go (80%)
Secondary progressive - follows on from relapsing remitting, less remission and more symptoms
Primary progressive - symptoms gradually develop and get worse over time

Question 3

How is MS diagnosed?

Answer 3

Clinically
can use MRI to show dissemination in space
Can use nerve conduction studies

Question 4

How might MS present?

Answer 4

Visual - optic nerve commonly affected. Hemianopia
Eye movements - double vision common, lateral rectus often affected
Unsteady balance is common
Loss of memory in later stages
Numbness of perineum and genitalia with altered sphincter function

Question 5

What are some of the differentials for MS?

Answer 5

Hereditary spastic paraplegia
Sarcoidosis
Cerebral variant of SLE

Question 6

What changes occur to the CSF in MS?

Answer 6

Increase in protein with increase in Ig concentration

Question 7

What is the treatment for relapses of MS?

Answer 7

Episode of sudden increase of symptoms within 12-24 hours
Oral or IV methylprednisolone
Ensure UTI is always excluded as cause of exacerbation

Question 8

What disease modifying treatments are available for MS? (Aim to reduce relapses)

Answer 8

Interferon B - SC
Glatiramer - SC
Dimethyl fumarate - PO

Question 9

What is the main side effects of Interferon B?

Answer 9

Flu like symptoms for around 24 hours post injection

Question 10

What are some of the second line therapies for MS?

Answer 10

Natalizumab - IVI

Fingolimod - PO