Multiple sclerosis

Question 1

Define multiple sclerosis

Answer 1

A relapsing and remitting inflammatory demyelinating disease of the CNS. T cell mediated chronic autoimmune disease. ‘Disseminated through space and time’ - multiple sites attacked with >30days between attacks

Question 2

Pathology of MS

Answer 2

1. Demyelination of the CNS leading to acute neurological deficit - develop over days, last for weeks
2. Complete or almost complete recovery
3. As disease progress, recovery is slowed and there is residual deficit as axons are destroyed
4. Permanent neurological deficit and progressive disease

Question 3

Epidemiology MS

Answer 3

1. More common in women (except primary progressive)
2. More common further from the equator
3. More common in young (30y)
4. EBV exposure predisposes

Question 4

Types of MS

Answer 4

1. Relapse-remit
2. Primary progressive
3. Secondary progressive
4. Benign

Question 5

Clinical features of MS

Answer 5

3 characteristic:
1. Optic: blurred vision, optic neuritis (pain on eye movement)
2. Brainstem: diplopia, vertigo, dysphagia, nystagmus
3. Spinal cord: numbness, pins and needles, spastic paresis, neuropathic pain, intention tremor
Other: overactive bladder, sexual dysfunction, ataxia
Lhermitte’s sign

Question 6

What is Lhermitte’s sign?

Answer 6

Tingling down back of spine into limbs upon flexion of the neck

Question 7

What is Urthoff’s sign?

Answer 7

Symptoms worse in the heat

Question 8

Investigations for MS

Answer 8

1. Clinical + additional evidence if necessary. >2 CNS lesions disseminated in time and space
2. MRI with contrast - plaque detection. sensitive not specific
3. Lumbar puncture: oligoclonal bands IgG on CNS but not serum - CNS inflammation

Question 9

Diagnosis criteria for MS

Answer 9

1. > 2 CNS lesions disseminated in time and space
2. Exclusion of other likely conditions

Diagnosis is clinical - based on frequency of attacks and presentation

Question 10

Treatment of MS (lifestyle)

Answer 10

1. Smoking cessation
2. Exercise
3. Reduce stress
4. Avoid triggers and infection
5. Speech therapy, OT, PT, counselling

Question 11

Treatment of MS (drugs)

Answer 11

1. IV methylprednisolone during relapses
2. Disease modifying therapies: alemtuzumab + natalizumab (monoclonal antibodies) interferon beta - reduces relapses
3. Stem cell transplant

Question 12

Treatment of MS symptoms

Answer 12

1. Baclofen: spasticity
2. Gabapentin: neuropathic pain
3. Teach self intermittent catheterisation: incontinence
4. Botox: tremor