What area of the nervous system is affected by MS?
CNS (UMN signs)
What is MS?
Chronic autoimmune disease characterised by inflammatory plaques of demyelination in the CNS, disseminated in space and time
Who typically presents with MS?
30 year old female
What are symptoms of MS?
- Optic neuritis
- Transverse myelitis
- Spastic weakness
- Paresthesia
- Cognitive/visuospatial decline
- Trunk and limb ataxia
- Urine retention/incontinence
- Swallowing disorders
What phenomenon occurs in MS?
Uhthoff’s phenomenon (symptoms worsen with heat)
How do you diagnose MS?
Clinical McDonald criteria (refer to neuro early)
What is the disease course of MS?
Relapsing remitting then secondary progressive OR primary progressive
What might you see on other investigations in MS?
- MRI - plaques (sensitive but not specific)
- LP - oligoclonal bands of IgG on electrophoresis of CSF not present in serum suggest CNS inflammation
- Delayed visual, auditory and somatosensory evoked potentials
What DMARDs are used in relapsing remitting MS?
- Dimethyl fumarate (for mild/moderate)
- Alemtuzumab and natalizumab
How do you treat acute relapses of MS?
Methylprednisolone 0.5-1g/24h PO/IV for 3-5 days shortens acute relapses
What treatment can you give for symptom control in MS?
- Baclofen or gabapentin for spasticity
- Clonazepam, Botulinum toxin A injections for tremor
- Self-catheterisation or tolterodine for urgency/frequency
- Amantadine, modafinil, CBT, exercise for fatigue
