What is MS?
Inflammatory demyelinating disease of the CNS
What is the cause of demyelination?
Autoimmune response of T cells that cross the BBB
What is the course of MS?
Relapsing - remitting course
What are the sensory symptoms of MS?
Dysesthesia
Paraesthesia
Trigeminal neuralgia
What are the motor symptoms of MS?
Spastic weakness
Myelitis
What are the sexual/GU symptoms of MS?
Erectile dysfunction
Urine incontinence/retention
What are the GI symptoms of MS?
Swallowing disorders
Constipation
What are the cerebellar symptoms of MS?
Trunk and limb ataxia
Tremor
Slurred speech
Falls
What are the eye symptoms of MS?
Diplopia
Hemianopia
Optic neuritis
Visual phenomena
Pupil defects
What is optic neuritis?
Demyelination within optic nerve
What are the symptoms of optic neuritis?
- Subacute visual loss
- Pain on moving eye
- Colour vision impaired
- Resolves
- Initial swelling optic disc
- Optic atrophy (pale disc) seen later
- Relative efferent pupillary defect
Why is MS a clinically isolated syndrome?
Episodes of demyelination disseminated in space and time
What is the diagnostic criteria for MS?
Clinical diagnosis: Posers criteria
MRI based diagnosis: Macdonald criteria
What can be seen on MRI?
Lesion or plaques
What is the progressive phase of MS?
Loss of axons leads to development of persistent disability
Black holes on MRI
What are the symptoms of progressive MS?
- Fatigue
- Temperature sensitivity
- Paraesthesia
- Stiffness/spasms
- Balanced/slurred speech
- Bladder and bowel symptoms
- Diplopia, visual loss
- Swallowing problems
- Cognitive memory lability
What signs of MS can be seen on examination?
- Afferent pupillary defect
- Nystagmus
- Cerebellar signs
- Sensory signs
- Weakness
- Spasticity
- Hyperreflexia
- Plantar’s extensor
What are the 3 types of MS?
Relapsing Remitting (RRMS)- 85%
Secondary progressive (SPMS)
Primary progressive (PPMS)- 10-15%
What investigations are done for MS?
- Lumbar puncture
- Visual/somatosensory evoked response
- Relevant blood tests
- CXR
What is the treatment for MS?
Treat relapses: Oral/IV prednisolone
Disease modifying treatment
General health and diet
Symptomatic treatment
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