Flashcards in Multiple Sclerosis (Hon) Deck (18):
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
MS patients can present with almost any neurological symptom. Which ones are the common ones?
Gait disturbances (transverse myelitis)
Visual loss (optic neuritis)
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%)
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
What causes MS?
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)
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
-tropical zones: 5-10 per 100,000
-temperate zones: 50 per 100,000 (risk determined before 14)
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
*MS is diagnosed by ___*
Multiple lesions over space and time
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)
Tecfidera (dimethyl fumarate)
In general, used in pts with relapsing forms of MS (not primary progressive)
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
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
-SLE with cerebritis
-Polyarteritis nodosa with transverse myelitis
-Devic's disease (neuromyelitis optica)
-lymphoma or leukemia with CNS involvement
-vascular malformations (spinal cord AVM)
-infections (HIV, HTLV-1, EBV, CMV, West Nile Virus, Lyme disease, syphilis)
-granulomatous disease (sarcoidosis)
-metachromatic leukodystrophy, adrenomyeloleukodystrophy
What drugs treat spasticity of MS?
Baclofen (oral or intrathecal), tizanadine, diazepam, carbamazepine, Botox, dantrolene
What drugs treat intention tremor of MS?
What drugs treat urinary urgency (spastic bladder) of MS?
What drug treats urinary retention/hesitancy of MS?
What drugs treat painful dysesthesias of MS?
What drugs treat fatigue of MS?
Amantadine, modafinil, armodafinil, fluoxetine, buproprion, methylphenidate, pemoline, exercise