what is multiple sclerosis?
chronic cell-mediated autoimmune disorder characterised by demyelination in the CNS
what is the pathophysiology of multiple sclerosis?
- CD4-mediated destruction of oligodendroglial cells
- humoral response to myelin binding proteins
what is the pathological hallmark of multiple sclerosis?
plaques of demyelination and eventual axonal loss
what is the aetiology of multiple sclerosis?
- female
- age ~30
- genetic - HLA DRB1
- environmental - vitamin D
what are the 2 groups of MS?
- relapsing-remitting - which may become secondarily progressive (80%)
- primary progressive (10%)
what is relapsing-remitting disease in MS?
- most common form (~80%)
- acute attaches (e.g. lasts 1-2 months) followed by periods of remission
what is secondary progressive disease in MS?
- describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
- ~65% of relapsing-remitting progress to secondary progressive within 15 years of diagnosis
- gait and bladder disorders are generally seen
what is primary progressive disease in MS?
- accounts for 10% of patients
- progressive deterioration from onset
- more common in older people
what is the typical presentation of MS?
- sensory disease (patchy paraesthesia)
- optic neuritis
- internuclear ophthalmoplegia
- subacute cerebellar ataxia
- spastic paraparesis
- fatigue
- urinary incontinence
how does optic neuritis present?
- unilateral decrease in visual acuity over hours or days
- poor discrimation of colours (‘red desaturation’)
- pain worse on eye movement
- relative afferent pupillary defect
- central scotoma
what is internuclear ophthalmoplegia?
lesion in the medial longitudinal fasciculus (communication between the 6th nerve and 3rd nerve nucleus) of the brainstem
how is MS diagnosed?
at least two of:
* clinical history/examination
* imaging findings
* oligoclonal bands in the CSF
what are the typical imaging findings in MS?
periventricular white matter lesions seen on MRI (T2)
what are dawson fingers?
- radiological sign in MS
- seen on FLAIR images
- hyperintense lesions penpendicular to the corpus callosum
what are oligoclonal bands?
- distinct bands of immunoglobulin (Ig) G on westeron blot
- reflect various immunoglobulins seen on CSF electrophoresis and indicate the presence of an autoimmune process in the CNS
what factors are associated with worse prognosis in MS?
- older
- male
- motor signs at onset
- early relaspses
- many MRI lesions
- axonal loss
what is the management for an acute attack of MS?
1g of IV methylprednisolone every 24hours for 3 days
reduces the duration and severity of the individual attacks
what is given in a severe acute attack of MS that does not respond to glucocorticoids?
plasma exchange
what are the two groups of drugs used in the long-term management of relapsing-remitting MS?
- disease-modifying therapies
- symptomatic therapies
name some examples of injectable medications used in MS?
- beta-interferon
- glatiramer
increasingly effective = increasingly significant side-effects
name some examples of oral disease modifying agents in MS?
- dimethyl fumarate
- teriflunomide
- fingolimod
name some examples of biologics used in MS?
- natalizumab
- alemtuzumab
what are the management options for spasticity?
- baclofen
- botox
what are the management options for fatigue?
- modafinil
- exercise therapy
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Ischaemic Stroke54
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Meningitis22
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Haemorrhagic Stroke5
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Multiple Sclerosis31
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Parkinson's Disease30
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Third Nerve Palsy6
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Prolactinoma12
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Normal Pressure Hydrocephalus7
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Motor Neurone Disease15
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Lewy Body Dementia6
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Tremor7
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Bell's Palsy6
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Syringomyelia8
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Headache28
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Trigeminal Neuralgia6
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Raised Intracranial Pressure10
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DVLA16
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Brain Lesions18
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Reflexes4
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Myasthenia Gravis10
