Multiple Sclerosis Flashcards Preview

Neurology > Multiple Sclerosis > Flashcards

Flashcards in Multiple Sclerosis Deck (42):
1

what is multiple sclerosis

inflammatory dymyelinating disorder of the CENTRAL nervous system

2

what is a MS plaque

area of inflammation- this inflammation causes demyelination

3

is there a gender bias in MA

females: males
3:1

4

what is the usual age of onset of MS

30s/40s

5

plaques in MS are disseminated in time and place- what does this mean

affects different areas at different times

6

what is your chance of getting MS if your identical twin has it

one in 3

7

what increases your chances of getting MS

living further from the equator (both north and south)
having epstein barre virus
low vit D
if born in summer months (mother vit D deficient during pregnancy)

8

what are the clinical courses of MS

relapsing remitting (90%)
secondary progressive (relapsing remitting but start nor getting fully better)
progressive relapsing (progresisvely gets worse will occasional relapses ans slight remissions)
primary progressive (constant decline)

9

what are the clinical features of MS

pyramidal dysfunction- hypertonicity, weakness, hyper-reflexity
optic neuritis
sensory symptoms
urinary tract dysfunction
cerebellar and brain stem features
cognitive impairment
mental and physical fatigue

10

what are the features of pyramidal dysfunction

increased tone
spasticity (veolcity dependant, spastic catch)
brisk reflexes
weakness
extensors of upper limb weak
flexors of lower limbs weak

11

what are the features of optic neuritis

painful (sore on eye movements) visual loss
lasts for 1-2 weeks
most will improve
RAPD
(is inflammation of the optic nerve)

12

how many patient with MS will have/ have had optic neuritis

half

13

what sensory symptoms can you get in MS

pain,
parasthesia,
dorsal column loss (proprioception and vibration),
numbess (very sugestive of MS),
trigeminal neuralgia

common to have burning feeling, or feel like water running down leg

14

can you have pain and numbness at the same time

yes

15

what do you look for in all patients with trigeminal neuralgia

scan for MS

16

what do most people with MS present with

optic neuritis (50%)
sensory symptoms (50%)

17

what are the clinical features of cerebellar dysfunction (can happen in MS)

dysarthia
ataxia
nystagmus
intention tremor
post pointing (finger over shooting mark when eyes closed)
pendular reflexes (hyporeflexia and hypotonia)
dysdiadokinesis (inability to perform rapid alternating movements)

18

what are the features of brian stem dysfunction seen in MS

diplopia (CN VI palsy)
facial weakness (CN VII palsy)
internuclear ophthalmoplegia

19

what is affected in internuclear ophthalmoplegia

medial longitudinal fasciculus
(failure of adduction, nystagmus is aBducting eye (opposite side of lesion))

20

what urinary tract dysfunction can you get in MS

increased tone of bladder + irritability of detrusor muscles:
-frequency
-nocturia
-urgency
-urge incontinence
-retention

21

how is MS diagnosed

at least 2 episodes suggestive of demyelination
dissemination in place and time
exclude other diagnoses via blood tests
MRI (done for every patient)
CSF (LP)
neurophysiology

22

what are your MS differentials

vasculitis
granulomatous disoder (neurosarcoidosis)
vascular disease, stroke/ TIA
structural lesion
infection- HIV, syphilis, lyme disease
metabolic- B12/ folate deficiency

23

what is included in the blood test to exclude other diagnoses in MS

plasma viscosity (will be raised in vasculitis), FBC, CRP
renal live bone profile
auto anti body screen
borellia, HIV, syphilis serology
B12 and folate
vitamin D

24

what is seen in 90+% of MS patients in CSF

oligoclonal bands

25

what can a relapse of MS be

Optic neuritis, pyramidal problem, sensory problem, brain stem problem, anything really

26

what is the treatment for an acute MS exacerbation

mild- symptomatic
mod- oral steriods (methylprednisolone 500mg for 5 days- not more than 1/2 per year)
severe- admit, IV steroids (1000mg over 3 days)

27

what is the symptomatic treatment for pyramidal dysfunction

(e.g. weakness and spasticity)
physio
occupational therapy
anti spasmodic agent (although sometime spasticity can help with walking/ standing where there is weakness)

28

what are the treatment options for spasticity

physio
oral meds (baclofen, tizanidine= can cause floppiness and tiredness)
bo tox (into muscles if severe)
intrathecal baclofen/ phenol (end stage bed bound Tx)

29

what are the treatment options for sensory symptoms

anti convulsants (gabapentin- careful of dependency)
anti depressants (amitriptyline)
tens machine
acupunture
lignocaine infusion

30

what is detrusor sphyncteric dysfunction dyssenergia

bladder neck and detrusor muscle contracting at the same time

31

what are the treatment options for urinary dysfunction in MS

depends on symptoms- can just be lifestyle changes
bladder drill (training)
anti cholinergics (oxybutynin- for detrusor irritability and overactivity, can cause retention)
desmopressin
catheterisation

32

what is the treatment for fatigue in MS

occupational therapist do fatigue management
amantadine (can cause heart failure and seizures)
modafinil if sleepy
hyperbaric oxygen

33

does cannabis work in MS

can work in drug resistant spasticity in some patients

34

when is the best time to intervene in MS management

in relapsing remitting stage

35

what are the first line disease modifying therapies for MS

(given for moderate relapses 2-3 times per year)
-interferon beta (avonex, rebif, betaseron, extavia)
-glitiramer acetate
-tecfedira, aubagio

36

what are the second line disease modifying therapies for MS and when are they given

(if still having relaspes with 1st line treatment or if initial presentation severe)
-monoclonal antibody (tysabri, ocrevus)
-fingolimod, cladrabine

37

what are the third line disease modifying therapies for MS

-miroxantrone, lemtrada
-HSCT (stem cell transplantation)

38

how are interferons and glitiramer acetate administered and how effective are they

injectable (sc, im)
decrease relapse rate by a third
decrease severity of relapses by 50%

39

what is tecfidera and what does it do

oral drug
1st line for RR MS
44% reduction in relapse rate

40

what are fingolimod/ cadrabine

oral agents
2nd line for MS
>50% reduction in relapse rate, with significant effect of disease progression but more toxic (why 2nd line)

41

who gets monoclonal antibodies (tysabri) in MS

highly active relapsing remitting multiple sclerosis:
-Patients with rapidly evolving severe relapsing remitting multiple sclerosis

-Patients with high disease activity despite treatment with a interferon

42

how do monoclonal antibodies work in MS

activated T cells cross BBB via VCAM1 mediated by integrins (transendothelial migration)
then cause autoimmunne attack against myelin
tysabri stops the activation of these leukocytes (t cells)