Multiple Sclerosis and Inflammatory CNS disease

Question 1

At what age is the typical presentation of MS?

Answer 1

30s and 40s

Question 2

describe the 4 different courses of MS

how common are they?

Answer 2

Relapsing remitting is the most common (80%)

but 60% of RR develop secondary progressive

Primary Progressive (10%)

Question 3

what are the signs and symptoms of optic neuritis and how would you diagnose?

Answer 3

sudden painful visual loss

sight usually returns after 1-2 weeks

colour desaturation

RAPD- Relative Afferent Pupillary Defect

Diagnosis MRI

Question 4

what would be the signs and symptoms of cerebellar dysfunction?

Answer 4

ataxia,

intention tremor

past pointing

nystagmus

dysdiodokinesis

pendular reflexes,

dysarthria

Question 5

what are the urinary symptoms of MS?

Answer 5

lfrequency

nocturia

urgency

urge incontinence

retention

Question 6

what are the signs of Internuclear ophthalmoplegia?

What is the cause?

Answer 6

Diplopia

Failure to adduct one eye

Nystagmus in the abducted eye

lag

caused by damage to medial longitudinal fasciculus which permits conjugated eye movements

Question 7

where is the lesion likely to be when they patient is experiencing diplopia and can’t abduct their left eye. They are also experiencing weakness on the left side of their face

Answer 7

lesion in right brainstem and affectiong cranial nerves VI and VII

Question 8

what are the clinical features of MS?

Answer 8

Pyramidal dysfunction (spasticity, increased tone, weakness, extensors of upper limbs and flexors of lower limbs)

Optic neuritis

Sensory symptoms (paraesthesia, numbness, pain, loss of proprioception, trigeminal neuralgia)

Lr urinary tract dysfunction

Cerebellar & brain stem features

Cognitive impairment (reduced attention span, heavy fatigue)

Question 9

How is MS diagnosed?

Answer 9

Demonstration of lesions dissiminated in time and space.

at least 2 episodes suggesting demyelination

MRI reveals lesion

CSF- 90% have oligoclonal bands og IgG

Do bloods to rule out other causes

Question 10

what are the treatment options for spasticity?

Answer 10

Education

Physiotherapy

Oral medication - baclofen,tizanidine

I.M. Botulinum toxin

Nerve blocks

Intrathecal baclofen / phenol

Surgery (tendon release, or cutting nerve)

Question 11

what treatments are there for urinary tract dysfunction?

Answer 11

Anti cholinergics- oxybutynin

Demopressin

Catheters when there is no control

Question 12

how is fatigue treated in MS?

Answer 12

Amantadine

Modafinil

Question 13

what are the first line therapies for MS

Answer 13

»Interferon Beta – Avonex, Rebif, Betaseron, Extavia

»Glitiramer Acetate (Copaxone)

»Tecfedira

Question 14

what are the second line therapies?

Answer 14

»Tysabri

»Fingolimod

Question 15

what is the mechanism of tysabri?

Answer 15

Question 16

what is a risk of using tysabri?

Answer 16

activation of John Cunningham Virus which causes Progressive Multifocal Leukoencephalopathy

Question 17

when is mitoxantrone used?

how is it given?

What is the risk?

Answer 17

for relapsing progressive MS

12 infusions over two years

cardiac toxicity