Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

• an acquired, chronic, immune-mediated inflammatory condition of the CNS

Question 2

What are some risk factors of MS?

Answer 2

• Genetics
• Vitamin D deficiency
• Cigarette smoking
• Diet and obesity in early life
• Female gender

Question 3

What are the two phases of MS?

Answer 3

Inflammatory and degenerative phases

Question 4

What are the three patterns of disease in MS?

Answer 4

• Relapsing remitting (RR-MS)
• Secondary progressive (SP-MS)
• Primary progressive (PP- MS)

Question 5

What are the complications of MS?

Answer 5

Fatigue, pain, spasticity, ataxia, tremor, reduced mobility, urinary problems, mental health problems

Question 6

How is MS diagnosed?

Answer 6

Neurological examination, Imaging (MRI)

Question 7

How are acute management of relapses treated and what are its contraindications?

Answer 7

Oral methylprednisone 0.5g daily for 5 days
- started ASAP after onset and within 14 days
- C/Is - infection, poorly controlled diabetes, hypertension

Question 8

What are disease modifying treatments indicated for?

Answer 8

Relapsing forms of MS

Question 9

How would you manage fatigue in MS?

Answer 9

• Check sleep hygiene, alcohol and caffeine intake
• Treat depression, restless legs, spasticity, pain, bladder frequency
• Regular aerobic, balancing and stretching exercises including yoga
• Trial of amantadine HCl (off-label)

Question 10

How would you manage mobility problems in MS?

Answer 10

• Referral to rehab specialist and physiotherapist
• Fampridine (Fampyra) may improve walking speed CAUTION SEIZURES

Question 11

How would you manage spasticity in MS?

Answer 11

• Assess and treat aggravating factors
• Baclofen (1st line) or Gabapentin (2nd line, off-label)
• Physiotherapy

Question 12

How would you manage mental health issues in MS?

Answer 12

• Amitriptyline HCl (off-label) for emotional lability
• CBT

Question 13

How would you treat Oscillopsia (visual disturbance) in MS?

Answer 13

• Trials of Gabapentin or memantine (off-label)

Question 14

How would you treat urinary dysfunction in MS?

Answer 14

• Limit intake of caffeine and ‘vitamin waters’, management of constipation
• Antimuscarinics, e.g. oxybutynin, solifenacin, tolterodine.