Multiple Sclerosis - Presentation, Diagnosis & Management

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Multiple Sclerosis is a condition whereby the ( myelin sheathes, axons, cell bodies, dendrites ) of ( CNS tracts, PNS neurons ) are broken down. Lesions also appear in the ( CNS, PNS ), and these are referred to as ( plaques, cysts, aggregates ).

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Multiple Sclerosis affects ( only CNS tracts, only PNS neurons, both CNS tracts and PNS neurons )

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Multiple Sclerosis is more prevalent in ...

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Multiple Sclerosis tends to initially present ...

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To be specific, Multiple Sclerosis is the loss of the cells that produce myelin in the CNS, known as

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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?

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The pyramidal dysfunction associated with Multiple Sclerosis tends to cause spasticity/weakness/etc to the ( extensors, flexors ) of the upper limbs and the ( flexors, extensors ) of the lower limbs

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Which visual condition is present in 50% of MS sufferers, and is the first sign of MS in 20% of sufferers?

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How does Optic Neuritis present? (2 right answers)

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In most cases, optic neuritis is a self-resolving condition given a few months.

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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 .

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Trigeminal Neuralgia only tends to affect 2-4% of MS patients. These patients are typically treated using an anticonvulsant called

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What are the main two cerebellar manifestations of Multiple Sclerosis?

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Multiple Sclerosis can cause CNVI palsy. How would this present?

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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 ( abducting, adducting ) eye and is called ( Internuclear Ophthalmoplegia, Chronic Progressive Ophthalmoplegia, Internal Ophthalmoplegia )

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70-80% of Multiple Sclerosis sufferers have lower urinary tract problems. The most common are ( increased, decreased ) frequency and ( urge, stress, overflow ) incontinence.

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Amantadine is a drug commonly prescribed to Multiple Sclerosis patients suffering from

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For a diagnosis of Multiple Sclerosis to be confirmed, the patient must have suffered at least 2 episodes suggestive of demyelination.

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Name the criteria typically used to diagnose multiple sclerosis.
The Criteria

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Which imaging study should be conducted in order to diagnose Multiple Sclerosis?

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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 ( IgG, IgA, IgE ) on electrophoresis, which are inflammation markers found in 75–85% of people with Multiple Sclerosis.

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In the most basic sense, acute exacerbations of multiple sclerosis are treated by the following:
Mild: ( Symptomatic treatment, Watchful waiting, No treatment )
Moderate: ( Oral steroids, Oral anticonvulsants, Oral antidepressants )
Severe: Admit & give ( IV Steroids, IV Anticonvulsants, IV Antiepileptics )

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Baclofen is a medication used to treat ... in MS patients

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Sensory symptoms caused by MS (pain, paraesthesia, numbness, etc) can be treated by the following:
Anti convulsant, e.g. ❌
Anti depressant, e.g. ❌

Gabapentin

Amitriptyline

Amantadine

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The lower urinary tract dysfunction caused by multiple sclerosis can be treated by a Vasopressin Analogue called ...

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Despite this, the most common long term management of lower urinary tract dysfunction in multiple sclerosis patients is...

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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.
❌: Balances expression of pro- and anti-inflammatory agents in the brain & reduces number of inflammatory cells crossing the blood brain barrier.
❌: Shifts the population of T cells from pro-inflammatory Th1 T-cells to regulatory Th2 T-cells that suppress the inflammatory response.

Interferon Beta

Glitiramer Acetate

Interferon Gamma

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How are Interferon Beta & Glitiramer Acetate (Copaxone) administered in MS patients?

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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?

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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

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The presence of which Human Leukocyte Antigen predisposes to multiple sclerosis?

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Which type of multiple sclerosis is the most common?

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Match the MS types to its definition:
❌ = Bouts of disease which occur months/years apart. Between these bouts there is no worsening in the patient's disability.
❌ = Starts like relapsing remitting however then becomes a linear, constant attack on the myelin.
❌ = A constant attack on the myelin of the CNS - no bouts, just a constant disease state.
❌ = Bouts of disease which occur months/years apart. Between these bouts there is a progressive worsening of the condition.

Progressive Relapsing

Primary Progressive MS

Secondary Progressive MS

Relapsing Remitting MS

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Charcot's triad is indicative of Multiple Sclerosis. This consists of ...

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sign = Electric shock-like jerk which potentiates down the spine and radiates into the limbs when an individual bends their neck forwards.

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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