Week 11: Multiple Sclerosis

Question 1

What is a scotoma?

Answer 1

hole in the visual field

Question 2

What is optic neuritis?

Answer 2

• inflammation of the optic nerve
• causes pain and loss of vision
• frequently not visible (retrobulbar)
• good prognsosi
• high dose steroids speeds up recovery but has no effect on final acuity so is not prescribed
• 50% go onto develop MS within 10 years

Question 3

What is transverse myelitis?

Answer 3

• inflammation inside the spinal cord
• often mild with good prognosis
• purely sensory
• Lhermittes phenomenon - get an electric shock when you bend your neck
• may affect bladder
• 50% caused by viruses
• 50% go onto develop multiple sclerosis

Question 4

How do we diagnose MS?

Answer 4

• 2 attacks
• must be disseminated in time and place
• macdonald criteria 2017

Question 5

What is clinically definite MS?

Answer 5

Optic neuritis and transverse myelitis at different times

Question 6

What is not definite MS?

Answer 6

• Clinically isolated syndrome (CIS)
• myelitis and optic neuritis at the same time
• recurrent myelitis
• recurrent or sequential (opposite eyes) optic neuritis

Question 7

What is MS?

Answer 7

• commonest cause of neurological disability in young adults in the UK
• disease of the CNS
• an inflammatory reaction in the CNS causes loss of myelin and slowing of nerve conduction
• areas of demyelination
• loss of axons
• immune system attacks myelin

Question 8

Who gets MS?

Answer 8

• 2:1 F:M
• 30-40 years is typically age of onset
• high risk in europeans
• typical epidemiology of an autoimmune disease

Question 9

What is the name of the first humanised monoclonal antibody approved for treatment of MS?

Answer 9

Tysabri

Question 10

What is natalizumab?

Answer 10

• antibody that attacks adhesion molecules of leukocytes
• reduction in relapse rate is 80% which is the best treatment available
• however if you have JC virus at the time of treatment, you can catch progressive multi focal leukoencephalopathy (PML)

Question 11

What are the types of disease progression for MS?

Answer 11

1. Relapsing-remitting MS (most common)
2. Primary progressive MS (10%)
3. Secondary progressive MS (treatable, but not curable)

in most cases, there is a relapsing phase followed by a progressive phase