Multiple sclerosis

Question 1

What is the definition of multiple sclerosis?

Answer 1

Chronic progressive condition in which there is damage of the nerve sheeth

Question 2

How common is multiple sclerosis?

Answer 2

Prevalence of 60 per 10,000 in England

Question 3

What is the pathophysiology of multiple sclerosis?

Answer 3

• Autoimmune – starts in early childhood
• Multiple plaques of demyelination of nerves in the brain and the spinal cord
• Inflammation of the white matter – mediated by B cells and CD4 T cells
• Peripheral nerves are not affected
• Relapsing and remitting symptoms due to inflammatory oedema and partial remyelination
• Death normally from:
• UTI
• Uraemia
• Bronchopneumonia

Question 4

What are the risk factors/aetiology of multiple sclerosis?

Answer 4

• Woman

* EBV exposure in childhood

Question 5

What are the signs/symptoms of multiple sclerosis?

Answer 5

• Relapsing and remitting symptoms
• Optic neuropathy
• Blurred vision
• Unilateral eye pain
• Disc swelling and pallor on fundoscopy
• Brainstem demyelination
• Diplopia
• Vertigo
• Dysphagia
• Nystagmus
• Spine cord lesions
• Numbness
• Pins and needles
• Spastic paraplegia – weakness and stiffness in the leg muscles
• Final stages:
• Spastic tetraparesis – cerebral palsy affecting all 4 limbs
• Ataxia
• Brainstem signs
• Blindness
• Incontinence
• Dementia

Question 6

What investigations are conducted to diagnose multiple sclerosis?

Answer 6

• MRI
• Electrophysiological tests
• CSF
• ↑ Protein
• ↑ Cell count
• Oligoclonal IgG bands

Question 7

What are the pharmacological treatments for multiple sclerosis?

Answer 7

• Methylprednisolone – during relapse
• Β interferon
• Glatiramer acetate
• Natalizumab/mitoxantrone – 2nd line therapy
• Baclofen/dantrolene/benzodiazepines – muscle relaxants

Question 8

What are the non pharmacological treatments for multiple sclerosis?

Answer 8

• Urinary catheterisation
• Physiotherapy
• Occupational health
• Support via the multiple sclerosis society