What is MS?
Chronic degenerative disease of the CNS caused by immune mediated inflammatory processes resulting in demyelination and axonal degeneration in the brain and spinal cord
What is the specific condition the features have to fulfil to be classed as MS?
Dissemination in time and space- lesions in the CNS must hv occured in at least 2 different places and at least 2 different times
What are the different forms of the diesease?
Relapsing- remitting
Secondary progressive disease
Primary progressive disease
What is relapsing remitting
most common (85%)
Acute attacks (lasts 1 to 2 months) with complete recovery in between attacks
What is secondary progressive disease
Relapsing remitting patient who have deteriorated and developed neurological signs and symptoms between relapses
65% go from relapsing remittent to secondary progression
What is primary progressive disease
Accounts for 10% of patients
progressive deterioration from onset–> no relapsing remitting, straight progressive
Which demographics is MS most common in?
Female
20-40 years old
white population
What are the causes of MS?
Genetic
environmental factors like low VD, smoking and EBV
What are the clinical features of MS
Optic neuritis: colour blindness, pain moving eyes, unilateral impaired vision
Internuclear ophthalmoplegia
significant headache and fatigue
sensory disturbance
weakness after walking
leg cramping
bladder disorders (urinary incontinence)
Lhermitte’s sign
Hoffman’s sign
What is internuclear ophthalmoplegia
Lesion of the medial longitundinal fasciculus, blocking connection between contralateral sixth nerve nucleus and ipsilateral third nerve nucleus, affecting horizontal gaze
What symptoms does internuclear ophthalmoplegia have
ipsilateral impaired adduction in eye
nystagmus in OTHER abducting eye (view diagrams)
What UMN signs does it cause?
Positive babinski sign
spasticity
hyperreflexia
What is lhermitte’s sign
paraesthesia in limbs on neck flexion
What is hoffman’s sign?
flicking/ putting pressure on nail bed causing twitching of thumb or fingers
What is uhthoff’s phenomenon?
Neurological symptoms are exacerbated by increases in body temperature e.g. after hot baths or exercise
Typically affects eyes e.g. blurred vision
What investigations would you do to do with brain?
MRI brain with contrast
MRI spinal cord with contrast
. would see white things in the brain
CSF exam from lumbar puncture- would see oligoclonal bands- elevated IgG antibodies
What investigation do we do if there’s bladder dysfunction?
US KUB (Kidney Ureter Bladder) to assess bladder emptying
If there is significant residual volume, you have to do intermittent self-catheterisation
No significant residual volume- anticholinergics may improve urinary frequency e.g. oxybutynin/ tolterodine
What is the first line and second line of treatment for acute exacerbations?
1) IV glucocorticoids (methylprednisolone)
2) Plasma exchange
What is the 1st line for treating relapsing MS? What alternatives are there?
natalizumab (stops white blood cells from immigrating) / ocrelizumab
b) fingolimod
beta interferon (used to be 1st line but not as effective)
glatiramer acetate (same as above)
How do we treat spasticity
Baclofen (relieves the spasms, cramping, and tightness of muscles) or gabapentin
How do we treat oscillopsia (stationary objects appear to be moving)?
Gabapentin (reducing the abnormal electrical activity in the brain)
What are the complications of the prognosis?
UTI
Osteoporosis
Depression
Visual Impairment
Erectile dysfunction
Cognitive impairment
Impaired mobility
High relapse rate in the first 2 years after MS onset
What immune cells are involved?
Perivascular immune cell infiltration (CD3 T-cells and CD20 B-cells)
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MS23
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Encephalitis15
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Epilepsy48
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Stroke48
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Myasthenia Gravis26
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Bell’s Palsy16
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Chronic Fatigue Syndrome10
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Transient Ischaemic Attack17
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Parkinson's disease28
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Meningitis34
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Brain metastases9
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Brain abscess16
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Essential tremor10
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Malaria15
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Subdural Haemorrhage17
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Motor neurone disease17
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Migraine24
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Other headaches21
