Multiple sclerosis

Question 1

What is MS?

Answer 1

Idiopathic inflammatory demyelinating disease of the CNS, disseminated in space and time

Question 2

What are risk factors for MS?

Answer 2

Young females

In areas with low vitamin D e.g. Scotland

Question 3

What are Sx of MS?

Answer 3

Optic neuritis: pain on eye movement and loss of central vision

Transverse myelitis: weakness, sensory loss, incontinence

ED, anorgasmia

Look for a history of transient neurological symptoms which have then resolved, and may be worse with heat e.g. hot bath or exercise

Question 4

What Ix in MS?

Answer 4

A clinical diagnosis.

2 or more episodes of demyelination disseminated in time and space

Attacks should last > 1 hours and be > 30 days between attacks

Can also do:

MRI with gadolinium contrast: demyelination in >2 spaces, enhancing and non-enhancing

LP: oligoclonal bands of IgG using protein electrophoresis

Bloods: exclude other causes e.g. B12, folate, lyme

Visual evoked potentials can be done for optic neuritis

Question 5

What are different types of MS?

Answer 5

Relapsing remitting
Primary progressive
Secondary progressive
Progressive relapsing

Question 6

What are differentials for MS?

Answer 6

Myelopathy (cervical spondylosis)
Fibromyalgia
B12 
Peripheral neuropathy
Lymphoma 
GBS 
ALS

Question 7

What is Rx for MS?

Answer 7

Dimethyl fumarate
Alemtuzumab
Natalizumab
Fingolimod

Relapses: give methylprednisolone for 3-5 days

Question 8

What Rx for symptom control in MS?

Answer 8

Spasticity: baclofen or gabapentin

Tremor: botulinum toxin

Urgency/frequency: self-catherisation, or tolterodine

Fatigue: amantadine

Question 9

What are complications of MS?

Answer 9

Progressive disability: may need PEG fed due to inability to swallow

Depression

UTI

Osteopenia/OP

cognitive impairment

ED