Multiple Sclerosis

Question 1

What kind of cells mediate the immune reaction in MS?

Answer 1

T cells

Question 2

What causes the relapsing and remitting symptoms seen in MS?

Answer 2

The axons demyelinate but then the myeline sheath grows back incompletely and can demyelinate again.

Question 3

What causes the progressive symptoms seen in MS?

Answer 3

Prolonged demyelination causes axonal loss over time, which leads to deterioration in function.

Question 4

Give examples of some of the symptoms seen in MS?

Answer 4

Optic neuritis
Pyramidal dysfunction
Sensory symptoms
Lowere urinary tract dysfunction
Cerebellar & brain stem features
Cognitive impairment

Question 5

What are the clinical features of pyramidal dysfunction?

Answer 5

Increases muscle tone
Spasticity
Weakness
(Look in the extensors of upper limbs and the flexors of lower limbs)

Question 6

What is optic neuritis?

Answer 6

Painful visual loss that lasts for 1 - 2 weeks.

RAPD

Question 7

What sensory symptoms are seen in MS?

Answer 7

Pain
Paraesthesia
Dorsal column loss (loss of proprioception and vibration)
Numbness
Trigeminal neuralgia

Question 8

What are the symptoms of cerebellar dysfunction?

Answer 8

Ataxia
Intention tremor
Nystagmus
Past pointing
Pendular reflexes
Dysdiadokinesis
Dysarthria

Question 9

What is dysdiadokinesis?

Answer 9

Inability to perform rapid, alternating movements.

Question 10

What is dysarthria?

Answer 10

Difficulty speaking caused by a problem in the motor muscles of the mouth.

Question 11

What is a pendular reflex?

Answer 11

Muscle will osscilate after being tapped with a tendon hammen

Question 12

What nerve has been damaged if the patient has double vision?

Answer 12

Abducens (CNVI)

Question 13

What nerve has been damaged if their is facial weakness?

Answer 13

Facial (CNVII)

Question 14

What two drug treatments are used to treat fatigue seen in MS

Answer 14

Amantadine

Modanafil (If sleepy during the day)

Question 15

What are the three diagnostic criteria that must be reached for a diagnosis of MS to be made?

Answer 15

1. At least 2 episodes suggestive of demyelination
2. Dissemination in time of lesions
3. Dissemination in location of lesions

Question 16

What are the four types of MS?

Answer 16

1. Relapsing remitting
2. Primary progressive
3. Secondary progressive
4. Progressive relapsing

Question 17

If a patient who has had relapsing remitting MS for 13 years now complains of a constant numbness in their legs and finds daily living more difficult. What is the likely diagnosis?

Answer 17

Secondary progressive MS

Question 18

What drug treatment would you use for a patient having a moderate acute exacerbation of their MS?

Answer 18

Oral steroids

Question 19

What oral medications help with the spasticity associated with MS?

Answer 19

Baclofen

Tizanidine

Question 20

What IM injection is used in the treatment of spasticity in MS?

Answer 20

Intra muscular botulinum toxin

Question 21

What are the first line disease modifying drugs used in MS?

Answer 21

Interferon beta
Glitramer Acetate (Copaxone)
Tecfedira

Question 22

What are the second line disease modifying drugs used in MS?

Answer 22

Tysabri

Fingolimod

Question 23

What are the third line disease modifying drugs used in MS?

Answer 23

Mitoxantrone

Question 24

How are interferon beta and copaxone given?

Answer 24

SC or IM

Question 25

What is the first line drug in relapsing remitting MS?

Answer 25

Tecfidera

Question 26

What drug therapies are given to patients with highly active rapidly evolving relapsing remitting MS?

Answer 26

Tysabri and Fingolimod

Question 27

What drug therapies are given to patients who have high MS disease activity despite treatment with interferon?

Answer 27

Tysabri and Finglimod

Question 28

What rare viral disease is associated with tysabri use?

Answer 28

Progressive multifocal leukoencephalopathy (inflammation of the white matter of the brain at several distinct points) - caused by the JC virus

Question 29

How is Fingolimod given?

Answer 29

Orally

Question 30

How is mitoxantrone given?

Answer 30

As 12 infusions over 2 years

Question 31

What dose related side effect is seen with mitoxantrone?

Answer 31

Cardiac toxicity

Question 32

What particular glial cells are affected in MS?

Answer 32

Oligodendrocytes

Question 33

Does MS affect the CNS or PNS?

Answer 33

CNS

Question 34

What symptoms do you get if there is internucleur opthalmoplegia?

Answer 34

Slowed/absent adduction in one eye and compensatory nystagmus in the other

Question 35

On asking a patient to look to the left you notice that the right eye doesn’t appear to move and that there is nystagmus in the patients left eye. What is this called and what structure is damaged?

Answer 35

Damage to the right medial longitudinal fasiculus.

Internuclear opthalmoplegia.