Multiple sclerosis Flashcards
(35 cards)
1
Q
Describe MS?
A
- Inflammatory demyelinating disease
- Presence of episodic neurological dysfunction in at least 2 areas of CNS
- Brain, spinal cord, optic nerve
- Dissemintated in space/time:
- ie occuring at multiple sites, with >29 days between attacks
2
Q
Cause of MS?
A
- Exact aetiology unknown
- Genetic factors (>30% concordance in identical twins)
- Environmental factors (increasing incidence with latitude in the world)
- Roles of vitamin D and infection
3
Q
Mean age of onset?
Gender distribution?
A
30yrs average onset
3x more common in women
4
Q
Describe the presentastion of MS?
A
- Usually monosymptomatic
- Unilateral optic neuritis
- Corticospinal tract and bladder involvement is common
- Symptoms may worsen with heat (bath/exercise)
5
Q
What is optic neuritis?
A
- Inflammation of the optic nerve
- Pain on eye movement
- Reduced rapid central vision
6
Q
Describe the diagnostic criteria for MS
A
7
Q
Describe the tests for investigation of MS?
A
- Depends on the presenting symptoms
- MRI:
- Sensitive but not specific for plaque detection
- Can exclude other causes including cord compression
- CSF:
- Oligoclonal bands of IgG on electrophoresis that are not present in serum
- Suggests CNS inflammation
- Oligoclonal bands of IgG on electrophoresis that are not present in serum
- Delayed visual, auditory and somatosensory evoked potentials
8
Q
Describe the progression of MS?
A
- Relapsing-remitting course
- With time remission between relapses becomes incomplete -> disability
- Pregnancy does not alter progression rate
- May reduce during pregnany then increase for a few months after
- Then returns to normal course
9
Q
Name this type of MS?
A
Relapsing remitting
10
Q
Name this type of MS?
A
- Secondary progressive
- Symptoms worse over time, with or without relapses and remissions
- People progress to this from relapsing remitting
11
Q
Name this type of MS?
A
- Primary progressive (PPMS)
- Slowly worsening symptoms from the beginning
- No relapses or remissions
12
Q
Name this type of MS?
A
- Progressive relapsing (PRMS)
- Steady decline with relapses inbetween
- No remissions
13
Q
Name some lifestyle advice for MS that patients can receive?
A
- Take multivitamin containing vitamin D
- Stop smoking
- Avoiding stress
14
Q
Approaches to the management of MS?
A
- Disease-modifying drugs
- Treating relapses
- Symptom control
15
Q
Disease modifying drugs for MS?
A
- Mild-moderate disease
- Interferon-β
- Dimethyl fumarate
- More severe disease
- Monoclonal antibodies
- Alemtuzumab
- Natalizumab
- Monoclonal antibodies
16
Q
Treating relapses in MS?
A
- Methylprednisolone
- 3-5 day course
- Shortens length of acute relapses, but does not effect prognosis
- Should not be used more than twice/year
- SEs of steroids
17
Q
Name some symptoms that may need controlled in MS?
A
- Spasticity
- Tremor
- Urgnecy/frequency
- Fatigue
18
Q
How can spasticity be treated in MS?
A
- 1st line: Baclofen or gabapentin
- 2nd line: Tizanidine
- 3rd line: Benzodiazepines
19
Q
How can tremor be treated in MS?
A
- Botulinum toxin type A injections
- Improve arm tremor and functioning
20
Q
How can fatigue be treated in MS?
A
- Amantadine
- Cognitive based therapy
- Exercise
21
Q
Clinical features of MS?
A
22
Q
Eponyms of MS?
A
- Pulfrich effect
- Lhermitte’s sign
- Devic’s syndrome
- Charles Bonnet syndrome
- Uhthoff’s phenomenom
- Argyll Robertson pupil
23
Q
Describe Devic’s syndrome?
A
- (Neuromyelitis optica)
- MS variant with transverse myelitis
- Loss of motor, sensory, autonomic, reflex, sphincter function below lesion level
- Optic atrophy
- Anti-aquaporin 4 antibodies (698 oxford handbook)
24
Q
Describe Lhermitte’s sign?
A
- Neck flexion causes electric shocks in trunk/limbs
- Also present in cervical sponylosis, cord tumours and B12 deficiency
25
Describe Uhthoff's phenomenom in MS?
Worseneing of symptoms with head (bath, exercise)
26
Describe Charles Bonnet syndrome in MS?
* Reduced acuity/temporal blindness
* +/- complex visual hallucinations of facesm as well as animals, plants and trees
27
Describe Pulfrich effect in MS?
* Unequal eye latencies
* Causes disoreintation in traffic:
* Straight trajectories seem curved
* Distances are misjudged on looking sideways
28
Describe Argyll Robertson pupil in MS?
* Pupil is constrictive and unreactive to light
* But reacts to accomodation
* The iris may be patchily atrophied, irregular and depigmented
* Occurs in MS, neurosyphilis, DM, HIV, sarcoidosis
* (prostitutes pupil - accomodates but does not react
29
Risk factors for MS?
* Strong
* Female
* Northern latitude
* Weak
* Genetic factors
* Smoking
* Vitamin D deficiency
* Autoimmune disease
* Epstain barr virus (EBV)
30
Differentials for MS?
* Fibromyalgia
* Sleep disorders
* Vitamin B12 deficiency
* Peripheral neuropathy
* Guillain-Barre syndrome
31
Describe the first line investigations into someone with suspected MS?
* MRI brain:
* Hyperintensities in periventricular white matter
* MRI spinal cord:
* Demyelination lesions (especially cervical SC)
* FBC, TSH, vitamin B12 (all normal in MS)
32
Name some second line tests for investigating someone with MS?
* Anti-neuromyelitis optica antibody
* Present in Devic syndrome
* CSF evaluation
* Glucose, protein, cell count normal
* Oligoclonal bands and elevated CSF IgG
* Evoked potentials (most common visual)
* Prolongation of conduction
* Asymmetrical prolongation in visual evoked potentials
33
Treatment for acute relapse affecting function in MS?
Methylprednisolone + plasma exchange
34
First line treatment for relapsing-remitting MS?
* Immunomodulators
* + lifestyle modifications +/- non-pharmacological treatmeats
35
First line treatment for secondary progressive MS?
* 1st line:
* Siponimod or methylprednisolone
* 2nd line:
* Cladribine
