Flashcards in MS Deck (32):
What is MS?
Inflammatory demyelinating disorder of the CNS
Plaques disseminated in time and place
Are women or men more commonly affected by MS?
Female: male = 3:1
What are the different clinical courses of MS?
Relapsing remitting; 90%
What are the clinical features of MS?
Lr urinary tract dysfunction
Cerebellar and brain stem features
What are the symptoms of pyramidal dysfunction in MS?
Extensors of upper limbs
Flexors of lower limbs
What are the symptoms of optic neuritis?
Painful visual loss on eye movement
How long will optic neuritis last in MS?
What sensory symptoms are associated with MS?
Dorsal column loss; proprioception and vibration
What cerebellar symptoms are associated with MS?
Will cerebellar problems be contra or ipsilateral?
What brain stem dysfunctions are commonly seen in MS?
Diplopia; CN6 palsy
Facial weakness; CN 7 palsy
What causes internuclear ophthalmoplegia?
Medial longitudinal fasiculus
What will be seen in INO?
Distortion of binocular vision
Failure of adduction; diplopia
Nystagmus in abducting eye
What lr urinary tract dysfunctions are assoc with MS?
Increased tone of bladder neck; retention
Irritability of detrusor muscle; frequency, nocturia, urgency, incontinence
What is used for fatigue management in MS?
Modafinil if sleepy (?)
Fatigue management via occupational therapists
How is MS diagnosed?
At least 2 episodes suggestive of demyelination
Dissemination of plaques in time and place
Alternative diagnoses excluded
What scans are done for the diagnosis of MS?
MRI - T2 weighted
CT ALWAYS BEFORE LP PERFORMED
What is the DDx of MS?
Sarcoid (tend to have pulmonary and skin involvement along with arthralgia and uveitis)
Infection; HIV, syphilis, lyme disease
Metabolic disorder; B12/folate
What blood tests are routinely performed in the work up of potential MS?
PV, CRP, FBC
Borrelia (lyme), HIV, syphilis
B12 and folate
What is seen on CSF of those with MS?
Oligoclonal bands in 90+% of cases
What is the treatment of an acute relapse of MS?
Mild - symptomatic
Moderatie; oral methylprednisolone 500 mg for 5 days
Severe; IV methylprednisolone 1000 mg for 3 days
What are some common adverse effects of MS?
AVN of hip
What is the symptomatic tx for pyramidal dysfunction?
Don't always want to get rid of spasticity; if muscles very weak, the spasticity of them will be the only thing allowing the patients to stand up and walk
What are the anti-spasmodic agents used in spasticity?
PO; baclofen, tizanidine
Intrathecal baclofen/ phenol
What are the treatments for the sensory symptoms assoc with MS?
Anticonvulsant e..g gabapentin
What is the treatment for lower urinary tract dysfunction?
What are the 1st line disease modifying drugs used in MS?
Interferon beta; avonex, rebif, betaseron, extavia
What are the 2nd line disease modifying drugs used in MS?
Monoclonal Ab; tysabri, ocrevus
What are the 3rd line disease modifying drugs used in MS?
HSCT (stem cell transplantation)
What is a very serious side effect associated with tysabri?
If the patient is infected with JC virus; can activate and cause PML
What is PML?
Progressive multifocal leukoencephalopathy; fatal disease characterized by progressive inflammation of the white matter of the brain at multiple locations