3 x more common in women people aged 20-40 yrs ppl living in higher latitudes typical pt: white woman in 20s

MS Flashcards by Sanjana Shaunak

What is MS?

a chronic, cell-mediated autoimmune disorder characterised by demyelination in the central nervous system

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Who gets MS?

3 x more common in women

people aged 20-40 yrs

ppl living in higher latitudes

typical pt: white woman in 20s

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Outline the pathophysiology of MS

Immune mediated (cell infiltration + inflammation) demyelination of CNS neurones > nerve cell degeneration.

Electrical signal travel is disrupted > symptoms of MS

Early stages neurones re-myelinate > clinical remission.

Recurrent episodes > neuronal damage > permanent clinical deficit.

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What are the key characteristic features of MS in terms of when symptoms appear?

Dissemination is space (DIS)
Dissemination in time (DIT)
episodic
relapsing and remitting course

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What cells make myelin in the CNS

Myelin is made my oligodendrocytes in the central nervous system.

Schwann = peripheral

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Causes of MS

Genetic / Autoimmune / Environment factors

Multiple gene
EBV
Low vitamin D
Smoking
Obesity

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What are some common signs in initial presentation of MS (lecture BB)

Optic neuritis
Ataxia
Dizziness (vertigo)
Weakness
Diplopia
Bladder / bowel dysfunction
Neuropathic pain (e.g. trigeminal neuralgia)
sensory loss / disturbance in face or limbs

Other common:
Fatigue
Spasticity
sexual dysfunction
cognitive impairment (later)

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What are the names of subtypes of MS?

Relapsing - remitting disease

Secondary progressive disease

Primary progressive disease

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What is relapsing-remitting disease in MS?

Most common - 85% pts

acute attacks of disease ( 1-2 months) followed by remission.

further classified by:
- Active- new symptoms/lesions on MRI

-Worsening - disability increasing over time

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What is secondary - progressive disease in MS?

Pts who started with relapsing- remitting but have now deteriorated.(65% of R-R get w/in 15 yrs)

Pts have neurological signs and symptoms which are more permanent

Gait and bladder disorders common

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What is Primary progressive disease in MS?

10% of pts

Worsening and deterioration from onset on MS

Older pts more likely

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How is a diagnosis made in MS?

multiple lesions of the CNS occurring both in time (recurrent episodes) and space (different sites).

-consultant neurologist and be based upon the 2010 McDonald criteria

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What is the MacDonald criteria?

For diagnosis of MS

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What is the MacDonald criteria?

For diagnosis of MS (workbook)

Lesions consistent with an inflammatory process
No alternative diagnosis
Multiple lesions in time and space (Relapsing remitting MS)
Progressive neurological deterioration for 1 year (Primary progressive MS)

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How would you diagnose a relapse of MS?

Develops new symptoms
Has rapid worsening of existing symptoms
Symptoms last for more than 24 hours in the absence of infection or other cause after a stable period of one month or
more

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What investigations can be used to support a diagnosis of MS?

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MRI of brain / spinal cord for demyelination plaques - see high T2-signal intensity lesions on MRI

Analysis of CSF - would see oligocolonal bands on CSF electrophoresis

What type of MRI would you order for MS investigation?

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T2 weighted shows high signal (bright) lesions. Varying degrees of contrast show active / recent demyelination.

Also use MRI flair to show lesions (bright)

What findings do you see on MRI with a patient who has MS?

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High signal T2 lesions
Periventricular plaques
Dawson fingers (FLAIR) - hyperintense lesions perpendicular (sticking up like mohawk) from corpus callosum.

What does analysis of CSF show in a patient with MS?

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Immunoelectrophoresis is performed showing oligoclonal bands of IgG

increased intrathecal IgG synthesis

What visual features do you get with MS?

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optic neuritis: common presenting feature

optic atrophy

Uhthoff’s phenomenon: worsening of vision following rise in body temperature e.g. bath

internuclear ophthalmoplegia

What sensory features do you get with MS?

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pins/needles

numbness

trigeminal neuralgia

Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion

What motor features do you get with MS?

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spastic weakness: most commonly in legs

What cerebellar features do you get with MS?

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Ataxia: depending on where the plaque is:
-Sensory (proprioception, Romberg)
- Cerebellar (co-ordinating movement)

Tremor

What are some ‘other’ features of MS ? i.e. not motor, sensory, visual or cerebellar

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urinary incontinence

sexual dysfunction

intellectual deterioration

Who is involved in management of MS pt?

MDT neurologists specialist nurses physio OT Patient education is key

What is the treatment fo an acute relapse of MS?

High dose steroids IV/ oral methylprednisolone for 5 days Shortens relapse (no impact on recovery to baseline)

What disease modifying drugs do you give for MS? And why

Change in management of MS- Disease modifying drug to induce long term remission. [LECTURE BB] Immune modulating drugs: 1 st line – Beta-Interferon • Interferon beta 1a IM (Avonex) • Interferon beta 1a SC (Rebif) • Interferon beta 1b SC (Betaferon) – Glatiramer acetate (Copaxone) • 2nd line/ Immunosuppressant drugs – Natalizumab (Tysabri) e.g. IV monoclonal AB

What are some of the potential side-effects of interferon-beta? | ques med

* Local inflammatory/hypersensitivity reactions at injection sites * Influenza-like symptoms * Malaise * Mood changes (e.g. depression) * Fever * Anaphylaxis * Alopecia * Hepatitis * Myalgia * Nausea and vomiting

What are options for symptomatic treatment in MS for fatigue *common*

Once excluded anaemia, thyroid, depression Then can trial Amantadine Other: CBT / Mindfullness

What are options for symptomatic treatment in MS for Neuropathic pain?

Amitryptyline Gabapentin

What are options for symptomatic treatment in MS for Depression ?

Antidepressants / SRi's

What are options for symptomatic treatment in MS for incontinence

urgency / overflow etc. US to see bladder emptying If + residual volume - self catheterisation If - residual volume - anticholinergics e.g. oxybutynin (can worsen cognitive impairment)

What are options for symptomatic treatment in MS for spasticity?

Baclofen and gabapentin -1st Physiotherapy

What are options for symptomatic treatment in MS for Oscillopsia ?(visual fields appear to oscillate)

Gabapentin (maybe ignore this card haha)

Four core presenting syndromes in multiple sclerosis? | from quesmed

* Optic neuritis * Myelopathy (including partial and transverse myelitis) * Focal brainstem disease (including INO) * Cerebellar dysfunction (presenting as subacute ataxia)

What is the second most common ophthalmic presentation of multiple sclerosis?

INO - Internuclear ophthalmoplegia

What factors are associated with a worse prognosis of Multiple Sclerosis?

* Older * Male * Motor signs at onset * Early relapses * Many MRI lesions * Axonal loss

MS Flashcards

(37 cards)