Multiple Sclerosis (Hon) Flashcards Preview

Neuro II Final > Multiple Sclerosis (Hon) > Flashcards

Flashcards in Multiple Sclerosis (Hon) Deck (18):
1

Define multiple sclerosis

Disorder of brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbations & remissions), which result from loss of nerve tract insulation (myelin) at multiple sites in CNS

2

MS patients can present with almost any neurological symptom. Which ones are the common ones?

Paresthesia
Gait disturbances (transverse myelitis)
Weakness
Visual loss (optic neuritis)
Urinary difficulty
Dysarthria
Hemiparesis

3

What are the 4 types of MS?

Relapsing remitting (45-50%)
Secondary progressive (20-25%) (these pts begin their disease process in relapsing remitting category)
Primary progressive (15-20%)
Benign (10-15%)

4

What are some generalities of MS?

MS is a disorder of CNS
Most MS pts diagnosed in their 20's or 30's
Disorder is generally characterized by periods of exacerbation and remission
No single test can confirm diagnosis of MS. However, multiple studies can be used to help make diagnosis

5

What causes MS?

Essentially unknown
Probably some genetic susceptibility (3-5% lifetime risk of developing MS if first degree relative has MS)
Perhaps a childhood event or illness that sensitizes immune system to attack CNS myelin, followed by an adult event triggering disease process (viral infection, post-partum period)

6

Epidemiology of MS

Affects women more than men (1.5:1), with women generally having a more favorable course

Onset of disease between age 15-50 (average onset 29) years
-in general, earlier onset is a more favorable prognostic feature

Geographic distribution:
-tropical zones: 5-10 per 100,000
-temperate zones: 50 per 100,000 (risk determined before 14)

7

What studies are used to make diagnosis of MS?

MRI of head, C & T spine
-Typically see ovoid lesions of high signal on T2WI in periventricular white matter and in spinal cord. Acute lesions may enhance

Multimodality evoked potentials (SSEPs, VEPs, BAER)

Lumbar puncture for CSF analysis
-presence of oligoclonal bands and/or increased IgG index/synthesis rate are typical findings in MS patients

8

*MS is diagnosed by ___*

Multiple lesions over space and time

9

What drugs are used for "maintenance" in MS (to decrease frequency and severity of exacerbations and slow progression of disease)?

Avonex, Rebif (*Interferon Beta-1A)
Betaseron (*Interferon Beta-1B)
Copaxone (*Glatirimer acetate)
Tysabri (natalizumab)
Gilenya (fingolimod)
Aubagio (Teriflunomide)
Tecfidera (dimethyl fumarate)
Lemtrada (Alemtuzumab)

In general, used in pts with relapsing forms of MS (not primary progressive)

10

What medications are used to treat acute exacerbation in MS?

High dose corticosteroids (solumedrol - 1 g IV daily for 3-5 days followed by prednisone taper)
Generally reduces length of exacerbation but is not thought to change overall outcome of it

11

What is the differential diagnosis for MS?

Nearly impossible to differentiate a first time MS attack from a post-infectious or post-immunization encephalomyelopathy (ADEM: Acute disseminated encephalomyelitis)
-ADEM should never recur, however. If pt develops future symptoms or new lesions on MRI, MS is more likely diagnosis

Autoimmune disease:
-SLE with cerebritis
-CNS vasculitis
-Polyarteritis nodosa with transverse myelitis

Others
-Devic's disease (neuromyelitis optica)
-B12 deficiency
-lymphoma or leukemia with CNS involvement
-spinocerebellar ataxias
-vascular malformations (spinal cord AVM)
-infections (HIV, HTLV-1, EBV, CMV, West Nile Virus, Lyme disease, syphilis)
-granulomatous disease (sarcoidosis)
-metachromatic leukodystrophy, adrenomyeloleukodystrophy

12

What drugs treat spasticity of MS?

Baclofen (oral or intrathecal), tizanadine, diazepam, carbamazepine, Botox, dantrolene

13

What drugs treat intention tremor of MS?

Propranolol
Primidone
Clonazepam

14

What drugs treat urinary urgency (spastic bladder) of MS?

Oxybutinin
Detrol LA

15

What drug treats urinary retention/hesitancy of MS?

Bethanechol

16

What drugs treat painful dysesthesias of MS?

Carbamazepine
Oxcarbamazepine
Gabapentin
Phenytoin
Baclofen

17

What drugs treat fatigue of MS?

Amantadine, modafinil, armodafinil, fluoxetine, buproprion, methylphenidate, pemoline, exercise

18

Describe Devic's disease (neuromyelitis optica (NMO))

Sometimes considered a variant of MS but is probably a different entity
Characterized by inflammation and demyelination of optic nerves and spinal cord (often long segments of spinal cord) with relative sparing of brain
Can use fairly sensitive and specific testing for NMO (Aquaphorin) antibodies in blood and CSF
Treatment is generally steroids and/or plasma exchange followed by immunosuppresion (azothiaprin, mycophenolate mofetil, or rituxumab)