Multiple Sclerosis Flashcards by Erin Sanderson

Is MS a disease of the old or young?

Young

How well did you know this?

Not at all

Perfectly

What is MS?

An autoimmune inflammatory disease that affects the myelin sheath surrounding neurons

How well did you know this?

Not at all

Perfectly

Is MS a grey or white matter disease?

White matter

How well did you know this?

Not at all

Perfectly

What type of process is demyelination?

Inflammatory

How well did you know this?

Not at all

Perfectly

Is MS a disease of the CNS or PNS?

CNS

How well did you know this?

Not at all

Perfectly

How does MS manifest?

Depends where the inflammation of the myelin is present

How well did you know this?

Not at all

Perfectly

How does demyelination occur?

Activated T cells cross the BBB and attack causing demyelination

How well did you know this?

Not at all

Perfectly

What can be seen on an MRI of MS?

Lesions or plaques of scarring where the myelin has attempted to repair itself
Black holes

How well did you know this?

Not at all

Perfectly

Which country has the highest prevalence of MS?

Scotland

How well did you know this?

Not at all

Perfectly

Does MS affect more M or F?

How well did you know this?

Not at all

Perfectly

Describe the relationship of MS to the earths equator?

The further you move away from the equator the greater the incidence of MS

How well did you know this?

Not at all

Perfectly

Is there a genetic link with MS?

Yes

How well did you know this?

Not at all

Perfectly

Which is the highest age group being diagnosed with MS?

20-30yrs

How well did you know this?

Not at all

Perfectly

What is the initial presentation of MS?

Present with a relapse of an attack of demyelination

How well did you know this?

Not at all

Perfectly

Give some examples of MS relapses

Optic neuritis 
Sensory symptoms 
Limb weakness 
Brainstem diplopia 
Vertigo 
Signs including or excluding the bladder (e.g urine incontinence)

How well did you know this?

Not at all

Perfectly

What are the symptoms of optic neuritis?

Subacute visual loss

Pain on moving the eye

How well did you know this?

Not at all

Perfectly

What are the signs of optic neuritis?

Initial swelling of optic disc
Optic atrophy
Relavent afferent pupillary defect

How well did you know this?

Not at all

Perfectly

What are the potential signs an symptoms of a brainstem relapse in MS?

Problems with eye movements (CN III,IV and VI)
Vertigo, nystagmus,
 ataxia (CNVIII)
Sensory involvement 
Upper motor neurone changes limbs

How well did you know this?

Not at all

Perfectly

Where can MS relapses occur?

Anywhere in the CNS

How well did you know this?

Not at all

Perfectly

What are some symptoms of an MS relapse?

Optic neuritis 
Sensory symptoms 
Limb weakness 
Brainstem diplopia/vertigo/ataxia 
Spinal cord - bilateral symptoms and signs +/_ bladder

How well did you know this?

Not at all

Perfectly

What is myelitis?

Inflammation of the spinal cord

How well did you know this?

Not at all

Perfectly

What is the definition of MS?

Episodes of demyelination disseminated in space AND time

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of myelitis?

Sensory level often with band of hyperaesthesia	Weakness/ upper motor neurone changes below level
Bladder and bowel involvement
-	urinary retention 
-	Constipation 
May be painful

How well did you know this?

Not at all

Perfectly

Is an isolated episode of demyelination MS?

No
MS = episode of demylelination disseminated in space and time
There has to be another episode

How well did you know this?

Not at all

Perfectly

Where is a common site for MS relapse?

Variable sites and severity Totally unpredictable Totally variable

What can be seen on examination in MS?

``` Depends on where demyelination has occurred and stage of disease: Afferent pupillary defect Nystagmus or abnormal eye movements Cerebellar signs (balance ect...) Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor ```

What is the diagnosis of MS?

Evidence of demyelination separated in time and space

How is MS diagnosed?

Can be clinical or MRI based

What criteria is used for clinical diagnosis of MS?

Posers criteria

What criteria is used for MRI diagnosis of MS?

Macdonald criteria

What other investigations can be done in MS apart from MRI?

LP | Bloods - to exclude other inflammatory conditions

How can a LP be useful in MS diagnosis?

Can look at oligoclonal bands If you have matched bands in the blood or serum then it is likely to be widespread inflammation occurring but if only present in the CSF then means it is isolated and diagnosed as MS

What are the types of MS?

``` Relapsing Remitting Secondary progressive Primary progressive Sensory Malignant ```

Who are prognostic indicators good for?

Female Present with optic neuritis Long interval between 1st and 2nd interval Few relapses in first 5 years

Who are prognostic indicators bad for?

Male Older age Multifocal symptoms and signs Motor symptoms and signs

When does primary progressive MS usually present?

50-60 yrs

Are there relapses in Primary progressive MS?

What is the prognosis for primary progressive MS?

Poor

What is | Neuromyelitis Optica Spectrum Disorder?

Variant of MS | Inflammatory demyelination causes attacks of optic neuritis and myelitis

What is a differential diagnosis for MS?

Progressive Multifocal Leukencephalopathy (PML) | Neuromyelitis Optica Spectrum Disorder:

What is Progressive Multifocal Leukencephalopathy (PML)?

Progressive multifocal leukoencephalopathy (PML) is a rare and usually fatal viral disease characterized by progressive damage or inflammation of the white matter of the brain

What is the treatment approach for MS?

Treat the symptoms not the disease

How should spastic muscles be treated?

Muscle Relaxants

How should dysaethesia be treated?

Amitriptyline

How should urinary problems be managed?

Bladder stimulator | Catheterisation

How should constipation be treated?

Laxatives

How should depression be treated in MS?

CBT

What treatment is used for MS?

``` Ocrelizumab Dimethyl Fumarate Beta-interferons Natalizumab Alemtuzumub ```

Does MS treatment reduce disease progression?

No but reduces relapse rate

What is the only disease modifying therapy approved for primary progressive MS?

Ocrelizumab

What are the side effects of MS treatment?

``` Flu-like symptoms Injection site reaction Abnormalities of blood count and liver function Reduce relapse rate ~1/3 No effect on progression of disability Not a cure ```

Who would be involved in the MS Multidisciplinary team?

``` MS nurse Physiotherapy Occupational therapy Speech and language therapy Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry ```

What is optic neuritis?

Inflammation of the optic nerve

What could be symptoms of a sensory attack?

Pins and needles Decreased vibration sense Dysaethesia

What could be symptoms of a GI relapse?

Swallowing problems | Constipation

What could be symptoms of a Sexual/GU relapse?

ED Urinary incontinence Urinary retention

What are general Rx advice for MS?

Regular exercise Stop smoking Avoid stress

What drug is used for treating relapses?

Methylprednisolone

Describe relapsing remitting MS

Most common Clearly defined as attacks followed by periods of partial or complete recovery/remission Gradual worsening over time

Describe Primary Progressive MS

Worsening neuroloigcal function from onset without relapses or remission Without relapses or remission

Describe secondary MS?

Follows initial relapsing-remitting course | Transition to progressive /decline without periods of remission

Describe Sensory MS

Those who have only ever had mild sensory episodes

Describe Malignant MS?

Severe disability in small period of time Very aggressive demyelination attacks Rapid decline in function