Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

A chronic and progressive autoimmune condition with demyelination of the CNS

Question 2

What are the types of MS?

Answer 2

• Primary Progressive (more common in older)
• Secondary progressive
• Relapsing-Remitting (most common)

Question 3

What is the pathophysiology of MS?

Answer 3

• Affects the oligodendrocytes in the CNS
• Inflammation and immune cell infiltration damage the myelin
• Lesions disseminated in time and space

Question 4

What are the risk factors for MS?

Answer 4

• Women
• Multiple genes
• EBV
• Low Vit D
• Smoking
• Obesity

Question 5

How does MS first present?

Answer 5

• Optic neuritis is often the first presentation (Demyelination of the optic nerve causing unilateral visual loss developing over hours/days)
• Uhthoff’s phenomenon: Worsening of symptoms after rise in body temperature
• Internuclear opthlamoplegia
• Pins and needles/numbness in the limbs
• Lhermitte’s sign: electric shock sensation in limbs/spine upon neck flexion
• Spastic weakness
• Ataxia and tremors

Question 6

How is MS investigated?

Answer 6

• MRI which will show typical lesions
• LP to detect oligoclonal bands in the CSF

Question 7

How is MS managed?

Answer 7

• High dose steroids for relapses
• DMARDs e.g natalizumab, ocrelizumab
• Baclofen/Gabapentin for spasticity
• Amantadine for fatigue