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Multiple sclerosis (Clinical
presentation (Special sensory
(visual)…
Multiple sclerosis
Clinical
presentation
Motor
Spastic weakness
Limb weakness
GI: swallowing difficulty, constipation
GU: urinary retention/incontinence,
ED, anorgasmia
Sensory
Abnormal sensation
(dysaesthesia, pins and needles)
-
-
Cognitive
-
Mood change
(depression, euphoria)
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-
-
-
Epidemiology
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Migrants take risk with them,
children have risk of where they live
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-
Pathophysiology
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Plaques of demyelination in the CNS
(cortex, brainstem, cerebellum)
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Natural history
Primary progressive
Progressive deficit from onset, no remission
-
Relapsing remitting
Commonest
Relapses of disease, recover inbetween
Progressive relapsing
Progressive deficit from onset, plus sporadic relapses
Diagnosis
Examination
Upper and lower limb
UMN findings (motor and sensory)
spasticity, weakness, hyperreflexia
May have reduced co-ordination
Reduced sensation
Cranial nerves
CN II: Hemianopia
CN III/IV/VI: diplopia, pupil defects, INO
CN IX/X: swallowing difficulty, dysarthria
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Investigations
Bloods
Autoantibodies (MOG, MBP, NMO-IgG)
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-
Special tests
Delayed evoked potentials
(visual, auditory, somatosensory)
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Diagnostic criteria
(McDonald criteria)
WMLs in CNS (clinically and radiologically)
disseminated in time (2+ separate episodes)
and place (2+ different body areas affected)
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-
Management
Medical
Symptomatic
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-
-
-
Pain
Anti-neuropathic agents
(gabapentin, pregabalin etc.)
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-
-
-
Conservative
Information
Nature and course
Prognosis (1/3 mild, mod, severe)
Live a normal life
MDT
MS nurse
Neurologist
PT, OT
Definition
Neurological disorder of
autoimmune aetiology
resulting in progressive
motor and sensory
degeneration separated
in space and time
-
-
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None: clinical evidence sufficient (MRI desirable)
Typical MRI findings or +ve CSF AND
2+ MRI lesions consistent with MS or 2nd relapse at new site
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Disseminated in time: MRI or 2nd clinical attack
Disseminated in space:
MRI OR +ve CSF if 2+ MRI lesions consistent with MS
AND disseminated in time (MRI or 2nd clinical attack)
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+ve CSF AND disseminated in space:
MRI of 9+ brain lesions
OR 2+ cord lesions
OR 4-8 brain and 1 cord lesion
OR +ve VEP and 4-8 brain lesions
OR +ve VEP +<4 brain lesions + 1 cord lesion **AND**
MRI disseminated in time
OR continued progression for >1y