Multiple Sclerosis

Question 1

What is the presentation of MS at the initial stage?

Answer 1

Initial Presentation:

• Initial attack of demyelination
• Gradual onset over days
• Stabilises over days to weeks
• Gradual resolution to complete or partial recovery

Question 2

How does MS present following relapse?

Answer 2

Relapse:

• Optic Neuritis (inflammation of optic nerve, causing temporary vision loss in usually 1 eye)
• Sensory symptoms
• Limb weakness
• Double vision/vertigo/ataxia
• Spinal cord with bilateral symptoms and possible bladder signs

Progressive

Question 3

How does MS present once the disease has progressed?

Answer 3

•Accumulation of symptoms and signs:

–Fatigue, temperature sensitivity

–Sensory

–Stiffness or spasms

–Balance, slurred speech

–Swallowing

–Bladder & bowel

–Diplopia/ oscillopsia/ visual loss

–Cognitive-dementia/ emotional lability

Question 4

What are the different courses of MS?

Answer 4

1) Relapsing remitting - 85%
2) Secondary progressive
3) Primary progressive - 10-15%
4) Sensory - 5%

Question 5

How is MS diagnosed?

Answer 5

1) Evidence of demyelination
2) Posers criteria (clinical - frequency of attacks and presence of lesions)
3) Macdonald criteria (MRI - to detect demyleination)

Lesions or Plaques:

• Demyelination may be seen on MRI

Question 6

What is the treatment of MS?

Answer 6

Symptomatic treatment:

1) Spasticity - muscle relaxants/antispasmodics
2) Dysaesthesia - amitryptyline
3) Urinary - Bladder stimulator

Medical:

1) Interferons
2) Prednisolone
3) Natalizumab
4) Alemtuzumub

Question 7

What are the clinical features of UMN & LMN lesions?

Answer 7

UMN - Brisk reflexes, increased muscle tone, spasticity, upgoing plantar reflex

LMN - muscle atrophy, absent reflexes, muscle fasciculations, weakness