Multiple Sclerosis

Question 1

What is MS?

Answer 1

Inflammatory Demyelinating Disorder

Question 2

Who is likely to get MS?

Answer 2

M:F - 1:3

30-40s

Question 3

What is the usually pattern of presentation in MS?

Answer 3

Relapsing and remitting symptoms present then disappear.

Question 4

What is the rarest form of MS?

Answer 4

Primary - no relapse

Question 5

List clinical features of MS.

Answer 5

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

Question 6

What pyramidal dysfunction is associated with MS?

Answer 6

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

Question 7

What occurs in MS related optic neuritis?

Answer 7

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

Question 8

What sensory symptoms are associated with MS?

Answer 8

Pain 
Paraethesia pins and needles
Proprioception and vibration
Numbness
Trigeminal Neuralgia

Question 9

What cerebellar dysfunction is associated with MS?

Answer 9

Dysarthria 
Ataxia
Nystagmus - involuntary eye movement
Intention tremor
Pendular reflex

Question 10

What brain stem issues are associated with MS?

Answer 10

Diplopia
VI palsy
Facial weakness VII

Question 11

Why do some patients with MS present with Internuclear opthalmoplegia?

Answer 11

Disturbance of binocular vision
Failure of abducens due to VI palsy
Nystagmus in abduction eye

Question 12

Why do MS patients present with urinary incontinence?

Answer 12

Increased tone at bladder neck and hypersensitivity

Question 13

What is required for a diagnosis of MS?

Answer 13

At least 2 episodes suggestive of demyelination and alternative diagnosis excluded.
Either one on MRI and one clinical or both on MRI

Question 14

What tests are undertaken in a suspected MS patient?

Answer 14

MRI CSF Neurophysiology Bloods

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Unmatched oligoclonal bands

Question 17

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

Answer 17

Purely symptomatic

Question 18

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

Answer 18

Oral steroids

Question 19

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

Answer 19

IV steroids and admission

Question 20

Symptomatic pyramidal dysfunction is treated how?

Answer 20

Physiotherapy
Baclofen - spasticity
Tizanidine -spasticity
Botulinum Toxin - spasticity

Question 21

What treatment is given for the sensory symptoms of MS?

Answer 21

Anticonvulsant - Gabapentin
Antidepressant - Amitriptyline
Acupuncture
Lignocaine infusion

Question 22

What can be used for the treatment of urinary incompetence?

Answer 22

Anticholinergics
Catheterisation
Bladder training

Question 23

What is the first line disease modifying drug?

Answer 23

Tecfedira
Aubagia
INFβ IV

Question 24

What are second line disease modifying drugs used in MS?

Answer 24

Monoclonal antibodies i.e Lemtrada

Fingolimod

Question 25

When are second line disease modifying drugs used?

Answer 25

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

Question 26

What are the third line disease modifying drugs?

Answer 26

Mitoxantrone | Stem cell transplant

Question 27

When are the third line disease modifying drugs used?

Answer 27

Very severe relapsing disease

Question 28

What is Tecfidera ?

Answer 28

1st line Oral agent 44% reduction in symptoms

Question 29

What is INFβ?

Answer 29

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

Question 30

What is Fingolimod?

Answer 30

2nd line Oral agents Toxicity means not 1st line

Question 31

What are some of the side effects of fingolimod?

Answer 31

Cardia toxicity Lower white cell count Hypertension

Question 32

List some common monoclonal antibodies.

Answer 32

Rituximab | Natlilizumab

Question 33

When is Rituximab used?

Answer 33

Highly active relapsing and remitting MS

Question 34

How does Natilizumab work

Answer 34

Bings to α4 integrin Prevents binding of lymphocyte to the VCAM on blood vessel wall Prevent lymphocyte migration out of the blood vessel.

Question 35

Describe plaques related to MS.

Answer 35

Well circumscribed and demarcated with an irregular shape often glassy and translucent. Massive variation in size

Question 36

What does an active plaque appear like?

Answer 36

Perivascular inflammation Microglia Ongoing demyelination

Question 37

What does an inactive plaque appear like?

Answer 37

Gliosis Few myelinated axons Reduced oligodendrocytes

Question 38

What is the association of MS with latitude ?

Answer 38

Further from the equator there is an increase in prevalence of MS.

Question 39

What is another primary cause of demyelination which isn't MS with a low mortality?

Answer 39

Acute disseminate Encephalomyelitis | Self limiting, full recovery with some defecits

Question 40

What is another primary cause of demyelination which isn't MS with a high mortality?

Answer 40

Acute haemorrhage leukoencephalitis

Question 41

What is a secondary cause of demyelination?

Answer 41

Central pontine myoclinosis

Question 42

What causes Central Pontine myoclinosis?

Answer 42

Too fast correction of hyponatraemia

Question 43

What virus can lead to. secondary form of demyelination?

Answer 43

JC virus

Question 44

What can lead to a toxic secondary form of demyelination?

Answer 44

Organic solvents

Question 45

List some environmental factors related to MS?

Answer 45

Vitamin D deficiency | Viral triggers e.g. EBV

Question 46

List some genetic factors related to MS?

Answer 46

HLA DRB Polymorphism in Interleukins Familial link

Question 47

What interleukins when mutated are linked to an increased risk of MS?

Answer 47

IL-2 | IL-7

Question 48

What forms the oligoclonal bands found in the CSF of someone with MS?

Answer 48

IgG