Multiple Sclerosis

Question 1

what is multiple sclerosis

Answer 1

autoimmune, chronic CNS disorder causing demyelination of oligodendrocytes

Question 2

RF for multiple sclerosis

Answer 2

female
20-40y
fhx
other autoimmunity
associated with trigeminal neuralgia

Question 3

where does multiple sclerosis occur

Answer 3

• optic nerves
• brainstem
• corpus callosum
• cerebral provinces

Question 4

3 types of MS

Answer 4

1. primary progressive
2. secondary progressive
3. relapsing/remitting

Question 5

what criteria used for MS

Answer 5

Mcdonald criteria –> 2 or more attacks disseminated in time and place

Question 6

what kind of signs present in MS

Answer 6

UMN only

Question 7

what pyrimidal UMN signs present in MS

Answer 7

• hyperrefleixa
• hypertonia
• babinksy +ve

Question 8

other sx of MS

Answer 8

• intention tremors
• ataxia
• dysarthria
• neuropathy
• chronic fatigue
• eye sx

Question 9

eye sx of MS

Answer 9

• diplopia
• optic neuritis
• RAPD
• internuclear opthalmoplegia
• pale optic disk

Question 10

what is RAPD

Answer 10

Relative Afferent Pupillary Defect - unequal pupil response to light

Question 11

what is internuclear opthalmoplegia

Answer 11

affected eye wont adduct

Question 12

key ddx for MS

Answer 12

neuromyelitis optica
- only affects eyes
- presents with aquaporin + antibodies in CSF

Question 13

dx of MS

Answer 13

Mcdonald criteria
type 2 MRI with contrast
LP
NCS

Question 14

what does MS mri show

Answer 14

attacks disseminated in space and time

Question 15

what does LP for MS show

Answer 15

oligoclonal igG bonds

Question 16

what do NCS for MS show

Answer 16

demyelination

Question 17

tx of acute MS

Answer 17

moderate - PO 500mg methylprednisolone 3days

severe - IV Ig methylpredisolone 3days

Question 18

long term MS treatment

Answer 18

DMARDS eg glatiramer or IV natalizumab

Question 19

how to manage spasticity in MS

Answer 19

baclofen

Question 20

how to manage neuropathic pain in MS

Answer 20

Gabapentin

Question 21

how to manage bladder issues in MS

Answer 21

oxybutinin

Question 22

how to manage eye issues in MS

Answer 22

pruritus

Question 23

how to manage fatigue in MS

Answer 23

modfanil