Multiple Sclerosis

Question 1

Does MS affect the CNS or PNS?

Answer 1

CNS

Question 2

What is the female: male ratio?

Answer 2

3:1

Question 3

What parts of the upper and lower limbs are affected ?

Answer 3

Extensors of upper limbs

Flexors of lower limbs

Question 4

Is there increased or decreased tone?

Answer 4

increased

Question 5

What other pyramidal dysfunction may occur?

Answer 5

spasticity

weakness

Question 6

Describe the onset of optic neuritis.

Answer 6

painful vision loss over 1-2 weeks

Question 7

Does optic neuritis tend to improve?

Answer 7

yes

Question 8

What defect occurs with optic neuritis?

Answer 8

relative afferent pupilllary defect

Question 9

List 5 sensory symptoms with MS.

Answer 9

pain
Paraesthesia
Dorsal column loss
(Proprioception & vibration)
Numbness
trigeminal neuralgia

Question 10

What is proprioception?

Answer 10

ability to sense where joints are without looking

Question 11

Describe trigeminal neuralgia.

Answer 11

Sudden severe, shooting, sharp facial pain

Question 12

Dysfunction of what may also occur, leading to dysdiadokinesia (impaired ability to perform rapid movements), dysarthria (problems with articulation of speech) and ataxia?

Answer 12

cerebellar

Question 13

Dysfunction of what leads to Diplopia (nerve VI palsy)
Facial weakness (nerve VII palsy)?

Answer 13

Brain stem

Question 14

What could cause impairment of adduction of eyes and distortion of binocular vision?

Answer 14

Internuclear ophthalmoplegia

Question 15

What symptoms may occur as a result of lower urinary tract dysfunction?

Answer 15

frequency
nocturia
urgency
urge incontinence
retention

Question 16

Does fatigue occur?

Answer 16

YES

Question 17

How is it diagnosed by history?

Answer 17

At least 2 episodes suggestive of demyelination with dissemination in time and place

Question 18

What does it mean by dissemination in time and place?

Answer 18

2 separate attacks separated by time, and also in different parts of the body

Question 19

Give an example of an anticholinergic which could be used to treat the lower urinary tract symptoms here.

Answer 19

oxybutynin

Question 20

Describe fatigue management which could be used.

Answer 20

Amantadine
Modafinil if sleepy
Hyperbaric oxygen

Question 21

1st line disease modifying therapy?

Answer 21

Interferon Beta – Avonex, Rebif, Betaseron, Extavia
Glitiramer Acetate (Copaxone)
Tecfedira

Question 22

2nd line disease modifying therapy?

Answer 22

Tysabri

Fingolimod

Question 23

3rd line disease modifying therapy?

Answer 23

Mitoxantrone

Question 24

When should Tysabri/Fingolimod be used?

Answer 24

Patients with rapidly evolving severe relapsing remitting multiple sclerosis

Patients with high disease activity despite treatment with a interferon