what is it?
2 problems going on:
A chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination
disseminated in both time and space.
how many visits do you need to confirm diagnosis?
two
CD4 cell mediated destruction of what?
leads to what?
oligodendrocytes
demyelination and eventual neuronal death.
98% of MS sufferers will have what when evaluating CSF from lumbar puncture?
suggests what?
Oligoclonal bands in CSF and IgG -
suggests CNS inflammation
classic patient?
age
gender
Most commonly in 20-40 year old white women.
most commonly presents with what?
acronym? TEAM
- Optic neuritis (unilateral blurring in one eye with pain on eye movement) .
- Peculiar sensoruy phenomena (pins+needles, tingling, sensation of a patch of wetness/burning)
tingling
Eye: optic neuritis
Ataxia
Motor: spastic parapesis
Ix for MS
what do you do first?
what is the most sensitive type of MRI for images of MS?
why do you look for Vit b12 in blood test?
MRI brain - hyperintensities of white matter
sagittal flair
vit B12 should be normal - but vit b12 deficiency can cause numbness, fatigue, vibration and proprioception loss.
RF for MS
female
northern latitude (further way from equator)
smoking
VIt D deficiency
what is Lhermitte’s sign?
neck flexion causes electric shocks in trunk and limbs
what criteria is used for MS?
Mcdonald’s
poor prognostic sign?
older males
motor signs at onset
many MRI lesions
different types of MS:
- primary progressive (straight line)
- secondary progressive (1st half triangles - 2nd half straight)
- relapsing-remitting (triangles and no straight line)
- progressive relapsing (upwards continual line with triangles the whole way)
- primary progressive: increase in disability from onset
- secondary: goes from relapsing remitting to progressive (into straight)
- relapsing remitting
- progressive relapse - increasing disability but with peaks along the whole way
Tx of MS
if there is a acute attack?
Methylprednisolone 1g IV/PO OD for 3 days
Tx of MS
what do you give to prevent relapse?
DMARDs
what do you need to confirm diagnosis?
Spinal MRI
what do you give for relapsing and remitting MS?
What Decreases relapses by 30% in relapsing remitting MS?
o Alemtuzamab (antiCD52 against T cells) OR o Natalizumab (VLA-4 receptor antagonist to stop immune cells crossing blood-brain barrier)
IFN-Beta
what medication can you give for spasticity or increased muscle tone?
Gabapentin or baclofen (both first line)
what can you give for tremor?
Propanolol or botulinum toxin type A injections
