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Flashcards in MS Deck (35):
1

what is multiple sclerosis

autoimmune inflammatory demyelinating disorder of the central nervous system
- chronic
- degenerative
- immune mediated

2

what are plaques

inflammatory areas

3

what does dissemination in time and space mean

plaques are found at different times in different places

4

does this disorder affect the PNS

no, it only affects the CNS

5

males/females are more affected by MS

females

6

what is the epidemiology and RF of MS

F>M
30-40s
those who live further away from the equator
genetics
EBV
HHV 6
vit D deficiency

7

what are the 4 clinical courses of MS

relapsing remitting
secondary progressing
progressive relapsing
primary progressive

8

define relapse/exacerbation

new symptoms / significant worsening of existing symptoms lasting more than 24 hours with preceding 30 days of clinical stability

9

list the clinical features of MS (6)

Pyramidal dysfunction
Visual symptoms
Sensory deficits
Lower urinary tract dysfunction
Cerebellar and brainstem dysfunction
cognitive impairment and fatigue

10

describe pyramidal dysfunction in MS

hypertonia and spasticity
hyper reflexia
weakness of upper limb extensors and lower limb flexors

11

describe visual disturbances in MS

optic neuritis
internuclear ophthalmoplegia

12

what is optic neuritis

painful visual loss because of inflammation of the optic nerve
RAPD seen

13

describe sensory deficits in MS

pain
paraesthesia
"water trickling" sensation
numbness
DCML loss
trigeminal neuralgia

14

describe lower urinary tract dysfunction in MS

frequency
urgency
urinary incontinence
urinary retention
nocturia

15

describe cerebellar and brainstem dysfunction in MS

DANISH symptoms
diplopia + facial weakness from CN palsies

16

describe internuclear ophthalmoplegia

impaired:
ipsilateral adduction
contralateral abduction nystagmus

17

how is a diagnosis of MS made

at least 2 episodes suggestive of demyelination
dissemination in time and space
alternative diagnoses excluded

18

what investigations are carried out to diagnose MS

history and clinical examination
MRI
CSF
neurophysiology
blood tests

19

what is MRI looking for

T2 weighted MRI to look for dissemination in time and space

20

what do you look for in CSF

oligoclonal bands

21

what blood tests are done

FBC
CRP
LFT
U+E
PV
bone profile
Ab screen
borellio
HIV
syphilis
serology
B12
folate
Vit D

22

what are differential diagnoses of MS

vasculitis
granulomatous disorders
vascular disease
structural lesion
infection
metabolic disorder

23

3 approaches to management of MS

acute exacerbation
symptomatic treatment
disease modifying therapy

24

steps in management of acute exacerbation

mild - symptomatic treatment
moderate - PO steroids
severe - IV steroids

25

give examples of symptomatic treatment for pyramidal weakness

PT + OT
anti-spasmodics
botox, intra thecal baclofen

26

give examples of symptomatic treatment for sensory symptoms

anticonvulsants
antidepressants
TENS machine
acupuncture
lignocaine infusion

27

give examples of symptomatic treatment for LUT dysfunction

reduce caffeine
anti cholinergics - oxybutynin
desmopressin
catheterisation

28

give examples of symptomatic treatment for fatigue

amantadine
modafinil if sleepy
hyperbaric oxygen

29

how many lines of therapy are there in disease modifying therapy

1st, 2nd and 3rd

30

list first line disease modifying therapy

Tecfidera PO
Interferon B and Glitiramer acetate - SC + IM

31

which drug is 1st line after RR MS

tecfidera

32

list 2nd line disease modifying therapy

Fingolimod and Cadrabine - PO
Tysabri

33

what kind of drug is tysabri

monoclonal antibody

34

what disease can tysabri cause

progressive multifocal leukoencephalopathy PML

35

list 3rd line disease modifying therapy

Mitroxantrone and Lemtrada
HSCT - horizontal stem cell transplant