Multiple Sclerosis

Question 1

What is MS?

Answer 1

A chronic and progressive autoimmune condition involving demyelination in the CNS.

Question 2

Who is more commonly affected by MS?

Answer 2

Women and individuals in high-income countries.

Question 3

What is the primary cause of demyelination in MS?

Answer 3

Destruction of myelin in the CNS - oligodendrocytes.

Question 4

What role do T cells play in MS?

Answer 4

Inflammation and immune cell (T cell) infiltration cause damage to myelin.

Question 5

What is a characteristic feature of MS lesions?

Answer 5

Lesions vary in location; affected sites and symptoms change over time.

Question 6

What are common risk factors for MS?

Answer 6

• Family history
• Females > males
• Aged 25-35
• Co-existing autoimmune conditions
• Smoking, obesity
• Epstein-barr virus
• Living at higher latitudes/vitamin D deficiency

Question 7

How is MS classified?

Answer 7

Spectrum of disease with varying rates of progression and severity of symptoms.

Question 8

What is Clinically Isolated Syndrome (CIS)?

Answer 8

An unexplained clinical episode of neurological dysfunction with radiological evidence of white matter pathology.

Question 9

What percentage of MS patients have Relapsing-Remitting MS (RRMS)?

Answer 9

Approximately 85%.

Question 10

What defines Secondary Progressive MS?

Answer 10

Initially presents as RRMS, then declines steadily without remission.

Question 11

What is the most aggressive form of MS?

Answer 11

Primary Progressive MS.

Question 12

What are the most common initial presentations of MS?

Answer 12

• Limb numbness/tingling
• Limb weakness (subacute onset)
• Cerebellar symptoms

Question 13

What is Uhthoff’s phenomenon?

Answer 13

Worsening of symptoms with exercise or in warm environments.

Question 14

What is Lhermitte’s phenomenon?

Answer 14

Lightning-shock pain down the spine on flexion of the neck.

Question 15

List common clinical features of MS.

Answer 15

• Increased pain
• Paraesthesia
• Double vision
• Fatigue
• Optic neuritis
• Dysphagia
• Slurred/stuttered speech
• Urinary frequency
• Urinary incontinence/retention
• Constipation/diarrhoea

Question 16

What examination findings can indicate optic neuritis?

Answer 16

• Pain on movement
• Visual field defect
• Loss of colour vision

Question 17

What is the gold standard for radiological investigation in MS?

Answer 17

MRI brain and spinal cord with contrast.

Question 18

What findings are expected in a lumbar puncture for MS?

Answer 18

• High protein content
• Oligoclonal bands of immunoglobulin

Question 19

What are the McDonald criteria used for?

Answer 19

Diagnosis of MS based on clinical and imaging findings.

Question 20

What does ‘disseminated in time’ mean in the context of MS diagnosis?

Answer 20

Clinical findings showing history of >2 attacks on >2 separate occasions.

Question 21

What is the treatment for an acute MS episode?

Answer 21

High-dose steroid therapy and plasmapheresis if refractory to steroids.

Question 22

List some long-term management strategies for MS.

Answer 22

• Injectible DMARDs (e.g., beta-interferon, glatiramer acetate)
• Oral DMARDs (e.g., dimethyl fumarate, fingolimod, cladribine)
• Ocrelizumab for slowing PPMS