List the 3 different types of multiple sclerosis
- relapsing remitting
- secondary progressive
- primary progressive (if severe, called fulminant)
What metabolic disturbances may cause MS-like symptoms
- thyroid problems
- B12 deficiency
Thus always do blood tests to exclude the above
Explain how MS is activated by the immune system
- viral infx (EBV) causes autoimmune reaction to occur
- inflammation in blood vessels around CNS white matter causes breach of BBB
- activated immune cells enter CNS through BBB
- immune cells attack and destroy myelin
Explain with reference to oligodendrocytes, why there is a relapsing remitting pattern in early stages of MS
Remaining oligodendrocytes remyelinate areas destroyed by immune cells.
(Note: new oligodendrocytes are NOT made)
Which is the main immune cells that causes the problems in MS
T lymphocytes
attack the oligodendrocytes
What is considered an MS attack
Any sign of increased inflammatory activity within the CNS that leasts >24h
Most common type of MS
relapsing remitting
which then develops to secondary progressive
Which type of MS presents later in life
Primary progressive (symptoms tend to present in late 40s/early 50s)
Optic neuritis symptoms in MS
- desaturation of colour
- smeary blurry vision
Transverse myelitis symptoms in MS
- UMN weakness below level of attack
- Numbness with sensory levels
- Bowel & bladder disturbance
Brainstem damage symptoms in MS
- Double vision
- Facial palsy
- Facial numbness
- Vertigo
- Dysarthria
- Ataxia
- Tremor
Paroxysmal (spasmic) symptoms in MS
- Lhermitte’s phenomenon (electrical shock sensation when putting chin on chest)
- Trigeminal neuralgia
- Tonic spasms
- Epilepsy
- Uthoff’s phenomen (heat sensitivity)
What is Lhermitte’s phenomenon?
electrical shock sensation when putting chin on chest
What is Uthoff’s phenomen?
Heat sensitivity
In what sort of MS patients should steroids be given
Patients presenting with recent symptoms (within the last week)
Limitations of steroid treatment for MS
- Not effective for slowly accumulated problems
- Don’t affect disease progression
- Don’t affect long term outcome of relapse
What other autoimmune condition commonly presents similarly to MS
Myasthenia gravis
What is often the first symptom to present in Myasthenia gravis patients?
How to differentiate from MS?
Ptosis and diplopia
Differentiating MG from MS:
Muscles are easily fatiguable. Limbs will start out normally but fatigue quickly on exertion. Eyes are first to be affected as eye muscles used most often.
What class of drugs is used to treat acute relapses of MS
High dose corticosteroids
Where does positive Lhermitte’s sign indicate where the plaques in MS are?
Cervical spinal cord
