Multiple Sclerosis Flashcards
(20 cards)
Description: What is multiple sclerosis?
- Demyelinating white matter disease of the central nervous system that follows a relapsing remitting course
Description: What are the types of MS?
- Relapsing remitting MS
- Primary progressive MS
- Secondary progressive MS
Aetiology/ Risk Factors: MS is associates with what type of disease?
- Autoimmune disease
Aetiology/ Risk factors: State 3 risk factors for MS. (3)
- Temperate climates
- Vitamin D
- Epstein Barr virus
Pathology: Describe the pathology behind the demyelination in MS
- Activated T cells cross the blood brain barrier
- These T cells attack oligodendrocytes and myelin itself, leading to demyelination
- Due to the lesion, there is increased number of inflammatory cells, leading to acute inflammation of the myelin sheath and loss of function
Symptoms: How does a patient with MS initially present?
- A few days gradual onset of symptoms then it takes a few weeks to stabilise and eventually a partial or complete recovery
Symptoms/ signs: How many cases of MS present with a relapse and how does a relpase present? (1+^6)
80% of cases of MS present with a relapse
MS relapse presentation:
- Limb weakness (motor)
- Optic neuritis (inflammation of the optic nerve – almost always unilateral)
- Brainstem diplopia, vertigo/ataxia
- Bladder involvement (nerve signals to bladder delayed/ blocked due to demyelination)
- Spinal cord (myelitis)
- Sensory symptoms
Symptoms: In MS, what are the symptoms of optic neuritis? (3)
Optic neuritis symptoms:
- Subacute vision loss
- Reduced colour vision
- Pain on moving the eye
Signs: In MS, what are the signs optic neuritis? (3)
Optic neuritis signs:
- Relative afferent pupillary defect (RAPD) – patient’s pupil dilate when bright light is shone onto the unaffected/affected eye (LOOK UP!!!!)
- Optic disc swelling initially, optic atrophy (death of the retinal ganglion cell axons) seen later
Signs: In MS, what are the signs associates with a brainstem relapse?
Signs of brainstem relapse:
- Ophthalmoplegia (paralysis of the eye muscles due to lesions in CN III, IV, VI) (pons)
- Vertigo, ataxia and nystagmus (abnormalities in the cerebellum)
Symptoms/ Signs: What are the types of myelitis and how does this present? (1+3)
Myelitis may be partial or transverse (complete):
- Hyperaesthesia
- Upper motor neurone changes below level of demyelination
- Bladder and bowel involvement
Symptoms/ signs: How do further relapses of MS present?
AAA
Symptoms/ signs: As MS progresses, what symptoms and signs may present?
AAA
Signs: What signs can be seen on examination of a patinet with MS?
AAA
Invesitgations: What are the 2 types of ways to diagnose MS? (2)
Diagnosis may be
- Clinical (Posers criteria)
- MRI based (Macdonald criteria)
Investigations: What invesitgations do we perform for MS (5)
- MRI of the brain (shows plaques which correspond with areas of demyelination, black holes may appear, FIRST LINE)
- Analysis of CSF via lumbar puncture (look for oligoclonal bands on electrophoresis)
- Delayed visual/ somatosensory evoked response (evoked potential)
- Bloods (exclude other inflammatory conditions)
- Chest x-ray
Treatment: In MS, what are the different types of treaments?
- Treatment of relapse
- Disease modifying treatment
- General health and diet
- Symptomatic treatment
(Multi-disciplinary approach)
Treatment: In MS, how do we treat?
(a) Treatment of relapse
(b) Disease modifying treatment
(c) General health and diet
(d) Symptomatic treatment
(a) Treatment of relapse:
- Oral prednisolone/ Methylprednisolone
- Rehabilitation
- Symptomatic treatment
(b) Disease modifying treatments (1st line treatments):
- Beta-interfons
- Glatiramer acetate
- Teriflunomide
- Dimethyl Fumarate
2nd line agents:
- Fingolimod
- Ocrelizumab
- Cladribine
- Alemtuzumab
- Natalizumab
(c) General lifestyle advice (health and diet)
(d) Symptomatic treatment AAA
Complications: How can MS progress (4)
MS progression:
- Most patients develop progressive disability – axonal loss is important
- ¼ of those with MS: activities of daily living (ADL) not affected
- ¼ of those with MS: require a wheelchair
- 15% severely disabled quickly
Extra: In MS, who makes up the multi-disciplinary team? (8)
Members of the MS multidisciplinary team:
- MS nurse
- Physiotherapy
- Occupational therapy
- Speech and language therapy
- Dietician
- Rehabilitation specialist
- Continence advisor
- Psychology/ psychiatry
