Please enable JavaScript.
Coggle requires JavaScript to display documents.
Multiple Sclerosis (Clinical features (Eye:
Diplopia
Visual phenomena
…
Multiple Sclerosis
Clinical features
Sensory:
- Dys/paraesthesia
- ↓ vibration sense
- Trigeminal neuralgia
Motor:
- Spastic weakness
- Transverse myelitis
Eye:
- Diplopia
- Visual phenomena
- Bilateral INO
- Optic neuritis → atrophy
-
Optic Neuritis
PC: pain on eye movement, rapid ↓ central vision
Uhthoff’s: vision ↓ w/ heat: hot bath, hot meal, exercise
o/e: ↓ acuity, ↓ colour vision, white disc, central scotoma, RAPD
Cerebellum:
- Trunk and limb ataxia
- Scanning dysarthria
- Falls
GI:
- Swallowing disorders
- Constipation
Sexual/GU:
- ED + anorgasmia
- Retention
- Incontinence
-
Mx
-
MDT: neurologist, radiologist, physio, OT, specialist nurses, GP, family
Symptomatic
- Fatigue: modafinil
- Depression: SSRI (citalopram)
- Pain: amitryptylline, gabapentin
- Spasticity: physio, baclofen, dantrolene, botulinum
- Urgency / frequency: oxybutynin, tolterodine
- ED: sildenafil
- Tremor: clonazepam
-
Preventing Relapse: Disease Modifying
IFN-β: ↓ relapses by 30% in RRMS MS
Glatiramer: similar efficacy to IFN-β
Preventing Relapse: Biologicals
Natalizumab: anti-VLA-4 Ab
↓ Relapses by 2/3 in RRMS
Alemtuzumab (Campath): anti-CD52
2nd line in RRMS
Things to talk about
Definition
A chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and
space.
Epidemiology
- Lifetime risk: 1/1000
- Age: mean @ onset = 30yrs
- Sex: F>M = 3:1
- Race: rarer in blacks
Aetiology
Genetic (HLA-DRB1), environmental,
viral (EBV)
Pathophysiology
- CD4 cell-mediated destruction of oligodendrocytes →
demyelination and eventual neuronal death.
- Initial viral inflam primes humoral Ab responses vs. MBP
- Plaques of demyelination are hallmark
Classification
- Relapsing-remitting: 80%
- Secondary progressive
- Primary progressive: 10%
- Progressive relapsing
Presentation: TEAM
- Tingling
- Eye: optic neuritis (↓ central vision + eye move pain)
- Ataxia + other cerebellar signs
- Motor: usually spastic paraparesis
Ix
-
-
Evoked potentials: delayed auditory, visual and sensory
Abs
- Anti-MBP
- NMO-IgG: highly specific for Devic’s syn.
-
-