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Flashcards in multiple sclerosis Deck (22):
1

what is multiple sclerosis?

a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged

2

how does demyelination occur in MS?

activated T cells cross the blood brain barrier causing demyelination

3

what would you expect to see on an MRI of a patient with MS?

lesions or plaques

4

what is a "black hole"

area on an MRI where brain tissue has been lost as a result of inflammation in an MS plaque

5

how do most MS cases present?

with a relapse
an attack of demyelination or inflammation

6

what does the onset of MS present as?

gradual onset over days

7

what symptoms can present in an MS relapse?

optic neuritis
sensory symptoms
limb weakness
diplopia
vertigo
ataxia
can be bilateral spinal cord symptoms

8

what are some features of optic neuritis?

subacute visual loss
pain on moving eye
colour vision disturbed
initial swelling of optic disc

9

what MRI criteria is used to diagnose MS?

macdonald criteria

10

what investigations are used to diagnose MS?

MRI
CXR
bloods to exclude other inflammatory conditions

11

what are the different types of MS?

relapsing remitting
secondary progressive
primary progressive
sensory
malignant

12

what are some poor prognostic indicators for MS?

male
older age
multifocal symptoms and signs
motor symptoms and signs

13

what are some features of primary progressive MS?

no relapses
often presents in 5th and 6th decade
spinal symptoms
bladder symptoms

14

what are some features of devics disease?

optic neuritis
myelitis
aquaporin 4 antibodies
antibody negative in some cases

15

what are 1st line disease modifying MS treatments?

beta interferons/glatiramer acetate

16

what are some side effects of 1st line MS injective treatment?

flu like symptoms
injection site reaction
abnormalities of blood count and liver function

17

what are some 2nd line treatments for MS?

natalizumab
fingolimod tablets
alemtuzumub

18

what is progressive multifocal leukencephalopathy caused by?

JC virus

19

how do you screen for PML?

MRI annual
JC antibody blood and urine every 6 months

20

what should you try and exclude in an acute relapse of MS?

look for the underlying infection so you can exclude the worsening of usual symptoms with intercurrent illness

21

how is spasticity in MS treated?

muscle relaxants
antispasmodics
physio

22

how is dysaesthesia treated in MS?

amitryptiline
gabapentin