Multiple Sclerosis Flashcards

1
Q

Epidemiology of MS:

A

F>M 3:1
Age 20-50s
Caucasians
Most common non-traumatic neurological disability in young adults

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2
Q

Common initial presentation:

A
  1. Optic neuritis
  2. Brainstem or cerebellar symptoms.
  3. Partial transverse myelitis
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3
Q

Diagnostic criteria

A

Dissemination of disease related events in time (DIT) and space (DIS)

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4
Q

4 profiles in time:

A
  1. Relapsing Remitting (RR) - most common
  2. Secondary Progressive (SP)
  3. Progressive Relapsing (PR)
  4. Primary Progressive (PP)
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5
Q

Clinically Isolated Demyelinating Syndromes (CIDS):

A

When any of MS presenting symptoms occur in isolation (1. Optic neuritis

  1. Brainstem or cerebellar symptoms.
  2. Partial transverse myelitis)
    - If normal MRI - small increased risk of developing MS.
    - If abnormal MRI (new lesions)- 55% risk of MS
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6
Q

MS is associated almost exclusively with ___motor neuron signs.

A

Upper

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7
Q

CSF in MS:

A

CSF abrnomalities are more sensitive and specific (95%) than MRI.
CSF:
-Elevated IgG index and synthetic rate
-Presence of oligoclonal bands that are not present in paired serum sample

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8
Q

Evoked Potential (EP)

A

Response from visual and somatosensory stimuli can be delayed in MS - interrupted by demyelination.
Visual EP is most useful in diagnosis.
Establish DIS via Unilateral conduction delay of P100 potential with well-preserved waveform.

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9
Q

Tests to rule out other causes:

A

CBC, CMP, ESR, ANA, Vit B12, Select patients: infection, inflammation, hypercoag….

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10
Q

MS “attack”:

A

Appearance of new symptom or reappearance or worsening of old symptom. Lasts at least 48hrs before stabilize or improve. Most evolve over days and last days-weeks. >=30 days between attacks.

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11
Q

Psuedo attack

A

Worsening of symptom with increased body temp due to fever, exercise (Uthoff’s phenomenon), hot bath…

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12
Q

Lhermitte’s sign:

A

Electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward. Lesion in dorsal column or caudal medulla.

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13
Q

Prognosis:

A

Get worse.
M worse than F.
Worse if prominent early myelopathic or cerebellar presentation.
Younger onset do better
Optic neuritis onset do better.
Pregnancy and breast feeding is a protected time. If no breast feeding - increased risk.

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14
Q

Treatment

A

Several disease modifying therapies (DMT) - oral or injectable:
-Interferon beta-1b: injection

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