MS

Question 1

acute relapse Mx

Answer 1

high dose steroids for 5 days to shorten course
(don’t affect degree of recovery just length of flare)

Question 2

Indications for DMARDs

Answer 2

• relapsing remitting disease + 2 relapses in past 2 years + ablte to walk 100m unaided
• secondary progressive disease + 2 relapses in past 2 yrs + able to walk 10 (aided/unaided)

Question 3

Natalizumab

Answer 3

• monoclonal antibody –> antagonises integrin on surface of leukocytes
• inhibit migration of leucocytes across endothelium into blood brain barrier
• used first line (best evidence base)
• given IV

Question 4

Ocrelizumab

Answer 4

• humanised antibody CD20 monoclonal antibody
• often used first line too
• given IV

Question 5

fingolimod

Answer 5

• S1P receptor modulator
• prevents lymphocytes leaving lymph nodes
• oral forms available

Question 6

Mx of fatigue

Answer 6

• amantadine
• other options = mindfulness / CBT

Question 7

Spaciticity Mx

Answer 7

• baclofen and gabapentin first line
• physio is important

Question 8

Bladder dysfunction Mx

Answer 8

• in form of urgency / incontinence / overflow
• get USS to assess bladder emptying
• if signic residual volume = intermittent self catheterization
• if no signif residual volume = anticholinergics