Multiple Sclerosis lectures (Parts 1 & 2) given on 18/09/2018
https://en.wikipedia.org/wiki/Multiple_sclerosis_signs_and_symptoms#Internuclear_ophthalmoplegia is really good for a walkthrough of MS symptoms
Multiple Sclerosis is a condition whereby the [blank_start]myelin sheathes[blank_end] of [blank_start]CNS tracts[blank_end] are broken down. Lesions also appear in the [blank_start]CNS[blank_end], and these are referred to as [blank_start]plaques[blank_end].
To be specific, Multiple Sclerosis is the loss of the cells that produce myelin in the CNS, known as [blank_start]oligodendrocytes[blank_end]
Multiple Sclerosis tends to cause pyramidal dysfunction. This can cause such things as spasticity, weakness and increased tone. What is the main tract of the pyramidal tract group?
The pyramidal dysfunction associated with Multiple Sclerosis tends to cause spasticity/weakness/etc to the [blank_start]extensors[blank_end] of the upper limbs and the [blank_start]flexors[blank_end] of the lower limbs
Which visual condition is present in 50% of MS sufferers, and is the first sign of MS in 20% of sufferers?
How does Optic Neuritis present? (2 right answers)
Acute onset pain in eye upon eye movement
Central blurriness/visual loss
Peripheral blurriness/visual loss
Floaters in visual field
In most cases, optic neuritis is a self-resolving condition given a few months.
Some multiple sclerosis patients describe an intense pain of the face that can be triggered simply by light touch of the face. This condition is typically caused by impingement of one of the cranial nerves by a blood vessel, and is called [blank_start]Trigeminal Neuralgia[blank_end].
Trigeminal Neuralgia only tends to affect 2-4% of MS patients. These patients are typically treated using an anticonvulsant called
What are the main two cerebellar manifestations of Multiple Sclerosis?
Multiple Sclerosis can cause CNVI palsy. How would this present?
Inability to abduct the eyes, causing diplopia
Inability to gaze downwards, causing diplopia
Negative pupillary light reflex
In addition to this, Multiple Sclerosis can also cause difficulty in adduction of the eyes. This occurs when a plaque forms in the Medial Longitudinal Fasciculus and presents as Nystagmus of the [blank_start]abducting[blank_end] eye and is called [blank_start]Internuclear Ophthalmoplegia[blank_end]
Chronic Progressive Ophthalmoplegia
70-80% of Multiple Sclerosis sufferers have lower urinary tract problems. The most common are [blank_start]increased[blank_end] frequency and [blank_start]urge[blank_end] incontinence.
Amantadine is a drug commonly prescribed to Multiple Sclerosis patients suffering from
Emotional Issues (e.g. Depression)
For a diagnosis of Multiple Sclerosis to be confirmed, the patient must have suffered at least 2 episodes suggestive of demyelination.
Name the criteria typically used to diagnose multiple sclerosis.
The [blank_start]McDonald[blank_end] Criteria
Which imaging study should be conducted in order to diagnose Multiple Sclerosis?
Multiple Sclerosis may also be diagnosed by means of lumbar puncture to look for inflammation in the CNS. The CSF is tested for oligoclonal bands of [blank_start]IgG[blank_end] on electrophoresis, which are inflammation markers found in 75–85% of people with Multiple Sclerosis.
In the most basic sense, acute exacerbations of multiple sclerosis are treated by the following:
Mild: [blank_start]Symptomatic treatment[blank_end]
Moderate: [blank_start]Oral steroids[blank_end]
Severe: Admit & give [blank_start]IV Steroids[blank_end]
Baclofen is a medication used to treat ... in MS patients
Lower Urinary Tract Dysfunction
Sensory symptoms caused by MS (pain, paraesthesia, numbness, etc) can be treated by the following:
Anti convulsant, e.g. [blank_start]Gabapentin[blank_end]
Anti depressant, e.g. [blank_start]Amitriptyline[blank_end]
The lower urinary tract dysfunction caused by multiple sclerosis can be treated by a Vasopressin Analogue called ...
Despite this, the most common long term management of lower urinary tract dysfunction in multiple sclerosis patients is...
Pelvic floor muscle training
Anticholinergics e.g. Oxybutynin
If an individual is thought to be at risk of developing MS or has two relapses of the condition, disease modifying therapy can be prescribed.
Match each first line therapy to it's description.
[blank_start]Interferon Beta[blank_end]: Balances expression of pro- and anti-inflammatory agents in the brain & reduces number of inflammatory cells crossing the blood brain barrier.
[blank_start]Glitiramer Acetate[blank_end]: Shifts the population of T cells from pro-inflammatory Th1 T-cells to regulatory Th2 T-cells that suppress the inflammatory response.
How are Interferon Beta & Glitiramer Acetate (Copaxone) administered in MS patients?
In patients with highly active multiple sclerosis, whereby interferon beta and Copaxone are ineffective, what is the second line disease modifying agent that should be given?
Second line treatment can also come in the rather expensive form of monoclonal antibodies. Drugs such as Natalizumab are able to reduce the ability of inflammatory immune cells to attach to and pass through the cell layers lining the
White matter tracts of the brain (e.g. internal capsule)
Grey matter areas of the brain affected by MS such as the basal ganglia
myelin sheathes of CNS tracts
The presence of which Human Leukocyte Antigen predisposes to multiple sclerosis?
Which type of multiple sclerosis is the most common?
Match the MS types to its definition:
[blank_start]Relapsing Remitting MS[blank_end] = Bouts of disease which occur months/years apart. Between these bouts there is no worsening in the patient's disability.
[blank_start]Secondary Progressive MS[blank_end] = Starts like relapsing remitting however then becomes a linear, constant attack on the myelin.
[blank_start]Primary Progressive MS[blank_end] = A constant attack on the myelin of the CNS - no bouts, just a constant disease state.
[blank_start]Progressive Relapsing[blank_end] = Bouts of disease which occur months/years apart. Between these bouts there is a progressive worsening of the condition.
Primary Progressive MS
Secondary Progressive MS
Relapsing Remitting MS
Charcot's triad is indicative of Multiple Sclerosis. This consists of ...
[blank_start]Lhermitte's[blank_end] sign = Electric shock-like jerk which potentiates down the spine and radiates into the limbs when an individual bends their neck forwards.
Baclofen is a muscle relaxant used to treat [blank_start]muscle spasticity[blank_end]