Multiple Sclerosis Flashcards Preview

Neurology Year 3 > Multiple Sclerosis > Flashcards

Flashcards in Multiple Sclerosis Deck (48)
Loading flashcards...
1

What is MS?

Inflammatory Demyelinating Disorder

2

Who is likely to get MS?

M:F - 1:3
30-40s

3

What is the usually pattern of presentation in MS?

Relapsing and remitting symptoms present then disappear.

4

What is the rarest form of MS?

Primary - no relapse

5

List clinical features of MS.

Pyramidal dysfunction
Optic neuritis
Sensory symptoms
Cognitive impairment
Cerebellar dysfunction
Brain stem issues
Urinary incontinence
Fatigue

6

What pyramidal dysfunction is associated with MS?

Increased tone spasticity
Weakness
Flexor and extensor both affected the same.

7

What occurs in MS related optic neuritis?

Painful vision loss for 1-2 week
Most improve
Look for RAPD -Relative Afferent Pupillary Defect

8

What sensory symptoms are associated with MS?

Pain
Paraethesia pins and needles
Proprioception and vibration
Numbness
Trigeminal Neuralgia

9

What cerebellar dysfunction is associated with MS?

Dysarthria
Ataxia
Nystagmus - involuntary eye movement
Intention tremor
Pendular reflex

10

What brain stem issues are associated with MS?

Diplopia
VI palsy
Facial weakness VII

11

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

12

Why do MS patients present with urinary incontinence?

Increased tone at bladder neck and hypersensitivity

13

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

14

What tests are undertaken in a suspected MS patient?

MRI CSF Neurophysiology Bloods

15

What are some differential diagnosis's in a patient with MS like symptoms?

Vasculitis
Granulomatous
Structural lesions
Infection
Metabolic disorders
B12 deficiency
Folic acid deficiency

16

What are you looking for in the CSF of someone with MS?

Unmatched oligoclonal bands

17

If someone presents with acute mild MS what is the treatment?

Purely symptomatic

18

If someone presents with acute moderate MS what is the treatment?

Oral steroids

19

If someone presents with acute severe MS what is the treatment?

IV steroids and admission

20

Symptomatic pyramidal dysfunction is treated how?

Physiotherapy
Baclofen - spasticity
Tizanidine -spasticity
Botulinum Toxin - spasticity

21

What treatment is given for the sensory symptoms of MS?

Anticonvulsant - Gabapentin
Antidepressant - Amitriptyline
Acupuncture
Lignocaine infusion

22

What can be used for the treatment of urinary incompetence?

Anticholinergics
Catheterisation
Bladder training

23

What is the first line disease modifying drug?

Tecfedira
Aubagia
INFβ IV

24

What are second line disease modifying drugs used in MS?

Monoclonal antibodies i.e Lemtrada
Fingolimod

25

When are second line disease modifying drugs used?

In either resistant or severe early onset 2 episodes within a year.

26

What are the third line disease modifying drugs?

Mitoxantrone
Stem cell transplant

27

When are the third line disease modifying drugs used?

Very severe relapsing disease

28

What is Tecfidera ?

1st line
Oral agent
44% reduction in symptoms

29

What is INFβ?

Interferron β
SC or IM
Decreases rate and severity of relapses
Very few side effects

30

What is Fingolimod?

2nd line
Oral agents
Toxicity means not 1st line