Multiple sclerosis

Question 1

Define MS

Answer 1

DEFINITION: inflammatory demyelinating disease of the CNS

Question 2

What are the different types of MS?

Answer 2

1. Relapsing-Remitting MS
   • COMMONEST form - 80%
   • Clinical attacks of demyelination with recovery in between attacks - slow accumulation of disability
2. Secondary progressive MS
   initial relapsing remitting pattern then this stops and there is a gradual worsening of condition (no remylination). People with RRMS can go on to develop this.
3. Primary Progressive MS
   • Steady accumulation of disability with NO relapsing-remitting pattern
4. Clinically Isolated Syndrome
   • Single clinical attack of demyelination
   • The attack in itself does NOT count as MS
   • 10-50% progress to develop MS
5. Progressive relapsing MS - no recovery between bouts of demylination

Others;
Marburg Variant
• Severe fulminant variant of MS leading to advanced disability or death within weeks

Question 3

Explain the aetiology/risk factors of multiple sclerosis

Answer 3

• UNKNOWN
• Autoimmune basis with potential environmental trigger in genetically susceptible individuals (HLA- DR2).

• Immune-mediated damage to myelin sheaths results in impaired axonal conduction (damage to myelin on axons - can be repaired “remylination” - if unrepaired scar tissue/plaques form “sclerosis”).

• Risk Factors
○ EBV exposure
○ Prenatal vitamin D levels

Question 4

Summarise the epidemiology of multiple sclerosis

Answer 4

• UK prevalence: 1/1000
• 2 x as common in FEMALES
• Age of presentation: 20-40 yrs

Question 5

Where does demylination not occur in MS?

Answer 5

In MS there is NO peripheral nervous system demylination!

lesions are just on the White matter brain and spinal cord.

p.s. optic nerve is affected

Question 6

presentation of MS

Answer 6

Usually come with Sensory and/or visual deficit/loss

Peculiar sensory phenomena - hemibody; parastesias, sensory losses etc

◼ Acute loss of central vision in eye - scotoma of optic neuritis

◼ Mild pain on eye movement

◼ Worse after taking shower, drinking hot tea

Question 7

other things people with MS may complain of?

Answer 7

Leg camps - night or driving

Gradual onset of weakness after walking several streets leading to foot dragging or slapping

Fatigue
Urinary frequency, bwoel disturbance

Imablance

Question 8

Examination findings in MS?

Answer 8

Wide based gait
Ataxia

Brisk reflexes

Increased tone, Spasticity
Foot dragging/slapping

Question 9

MX of MS? 2022

Answer 9

Acute relapse;

1. Methylprednisolone IV
2. Plasma exchange

Relapsing remitting:
1. Inteferon B
+ manage sleep, urinary etc problems

dimethyl-fumarate?

Sensory symptoms (pain and paraesthesia): anticonvulsants/deppresants

Spasticity; Baclofen

Tremor; Propranolol