Multiple Sclerosis and Inflammatory CNS Disease Flashcards Preview

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Flashcards in Multiple Sclerosis and Inflammatory CNS Disease Deck (36):
1

what is MS?

inflammatory demyelinating disorder of the CNS in which there is plaques disseminated in time and place

2

when does MS typically initially present?

30s and 40s

3

what is ratio of females : males in MS?

3:1

4

what are the clinical features of MS?

pyramidal dysfunction

optic neuritis

sensory symptoms

lower urinary tract dysfunction

cerebellar and brain stem features

cognitive impairment

5

what are the symptoms of pyramidal dysfunction?

increased tone

spasticity

weakness

6

in which part of upper and lower limbs does pyramidal dysfunction occur?

extensors of upper limbs

flexors of lower limbs

7

what are the symptoms of optic neuritis?

painful visual loss which happens for 1-2 weeks

RAPD

8

which sensory symptoms are present in MS?

pain

paraesthesia

dorsal column loss (proprioception and vibration)

numbness

trigeminal neuralgia

9

what are symptoms of cerebellar dysfunction?

dysarthria

ataxia

nystagmus

intention tremor

past pointing

pendular reflexes

dysdiadokinesis

10

what are symptoms of brain stem dysfunction?

diplopia = R VI palsy

facial weakness = R VII palsy

internuclear ophthalmoplegia

11

what causes internuclear ophthalmoplegia?

lesion in medial longitudinal fasciculus

12

what are symptoms of internuclear ophthalmoplegia?

distortion of binocular vision

failure of adduction - diplopia

nystagmus in abducting eye

lag

13

what are symptoms of lower urinary tract dysfunction?

frequency

nocturia

urgency

urge incontinence

retention

14

what is given to treat fatigue in MS?

amantadine

modafinil if sleepy

hyperbaric oxygen

15

what is criteria for diagnosis of MS?

at least 2 episodes suggestive of demyelination

dissemination in time and place

alternative diagnosis excluded

16

what investigations help in diagnosing MS?

clinical

MRI

CSF

neurophysiology

blood tests

17

what are differential diagnosis of MS?

vasculitis
granulomatous disorder
vascular disease
structural lesion
infection
metabolic disorder

18

what is present in CSF in 90+% of MS cases?

oligoclonal bands

19

what is given in mild acute exacerbation of MS?

symptomatic treatment

20

what is given in moderate acute exacerbation of MS?

oral steroids

21

what is given in severe acute exacerbation of MS?

admit / IV steroids

22

how would you symptomatically treat pyramidal dysfunction (weakness and spasticity)?

physiotherapy
occupational therapy
anti spasmodic agent

23

what different types of anti spasmodic agents can be used?

oral - baclofen, tizanidine

botulinum toxin

intrathecal baclofen / phenol

24

how would you treat sensory symptoms (pain, paraesthesia, numbness, trigeminal neuralgia)?

anti convulsant - gabapentin

anti depressant - amitriptyline

tens machine

acupuncture

lignocaine infusion

25

how do you symptomatically treat lower urinary tract dysfunction?

bladder drill

anti cholinergics - oxybutynin

desmopressin

catheterisation

26

what is the three stages of MS therapy?

acute exacerbation

symptomatic treatment

disease modifying therapy

27

what is the first line disease modifying therapy for MS?

interferon beta - avonex, rebif, betaseron, extavia

glitiramer acetate

tecfidera, aubagio

28

what is second line disease modifying therapy for MS?

monoclonal antibody - tysabri, ocrevus

fingolimod, cladrabine

29

what is third line disease modifying therapy for MS?

mitoxantrone, lemtrada

HSCT (stem cell transplant)

30

how are interferons and glitiramer acetate given and what is their effectiveness?

injectable - sc and im

decrease relapse rate by a 1/3 and severity of relapse by 50%

31

how is tecfidera given and what is effectiveness?

oral agent which is first line in relapsing remitting MS

44% reduction in relapse rate

32

how do fingolimoid / cadrabine given and what is their effectiveness?

oral agents which NICE have approved as second line

>50% reduction in relapse rate

33

when is tysabri given?

single disease modifier given in highly active RRMS

pts with rapidly evolving severe RRMS and pts with high disease activity despite treatment with interferon

34

when should tysabri not be given?

when patient is JC virus positive

if given - develop PML

35

what is really good about interferon beta?

can give in pregnancy

36

what is the role of a4B1 in MS?

trans-endothelial migration of activated T cells across BBB in EAE mediated by integrins