Flashcards in Multiple Sclerosis Deck (48)
What is MS?
Inflammatory Demyelinating Disorder
Who is likely to get MS?
M:F - 1:3
What is the usually pattern of presentation in MS?
Relapsing and remitting symptoms present then disappear.
What is the rarest form of MS?
Primary - no relapse
List clinical features of MS.
Brain stem issues
What pyramidal dysfunction is associated with MS?
Increased tone spasticity
Flexor and extensor both affected the same.
What occurs in MS related optic neuritis?
Painful vision loss for 1-2 week
Look for RAPD -Relative Afferent Pupillary Defect
What sensory symptoms are associated with MS?
Paraethesia pins and needles
Proprioception and vibration
What cerebellar dysfunction is associated with MS?
Nystagmus - involuntary eye movement
What brain stem issues are associated with MS?
Facial weakness VII
Why do some patients with MS present with Internuclear opthalmoplegia?
Disturbance of binocular vision
Failure of abducens due to VI palsy
Nystagmus in abduction eye
Why do MS patients present with urinary incontinence?
Increased tone at bladder neck and hypersensitivity
What is required for a diagnosis of MS?
At least 2 episodes suggestive of demyelination and alternative diagnosis excluded.
Either one on MRI and one clinical or both on MRI
What tests are undertaken in a suspected MS patient?
MRI CSF Neurophysiology Bloods
What are some differential diagnosis's in a patient with MS like symptoms?
Folic acid deficiency
What are you looking for in the CSF of someone with MS?
Unmatched oligoclonal bands
If someone presents with acute mild MS what is the treatment?
If someone presents with acute moderate MS what is the treatment?
If someone presents with acute severe MS what is the treatment?
IV steroids and admission
Symptomatic pyramidal dysfunction is treated how?
Baclofen - spasticity
Botulinum Toxin - spasticity
What treatment is given for the sensory symptoms of MS?
Anticonvulsant - Gabapentin
Antidepressant - Amitriptyline
What can be used for the treatment of urinary incompetence?
What is the first line disease modifying drug?
What are second line disease modifying drugs used in MS?
Monoclonal antibodies i.e Lemtrada
When are second line disease modifying drugs used?
In either resistant or severe early onset 2 episodes within a year.
What are the third line disease modifying drugs?
Stem cell transplant
When are the third line disease modifying drugs used?
Very severe relapsing disease
What is Tecfidera ?
44% reduction in symptoms
What is INFβ?
SC or IM
Decreases rate and severity of relapses
Very few side effects