Multiple Sclerosis

Front 1

What is the pathological definition of MS?

Back 1

Inflammatory disease of the CNS characterised
by demyelination and variable degrees of axonal loss and gliosis.

Front 2

What is the clinical definition of MS?

Back 2

Objective CNS dysfunction, i.e. involvement of two or more white matter structures separated by time (1 months)*, with no other aetiology.

Front 3

What is the epidemiology of MS?

Back 3

• Age of onset - 3 rd / 4th decade (16 - 50 years)
• Prevalence - ~125/100,000 (latitude dependent)
• Life Span - slightly reduced (~ 10 years)
• Sex - F > M
• Race - Caucasians (uncommon in Chinese / ? Viking ancestral genes)
• Geography - Northern European Disease
• Familial clustering

Front 4

What are the risk factors for MS?

Back 4

• Genes
• Environment
• Sunlight/UVB
• vD
• EBV
• Smoking

Front 5

What is a particular genetic risk locus for MS?

Back 5

6p21

Front 6

Which month of birth is at most risk of MS?

Back 6

May

Front 7

What are possible aetiologies of MS?

Back 7

Infection - MMR, influenza

Autoimmune - MHC - HLA DRB1, association other AI, female, autoreactive T/B, pregnancy/viral effect, noninfectious

Front 8

Give the proposed MS disease model.

Back 8

Front 9

How does MS present?

Back 9

• Motor - spasticity, weakness and gait abnormalities.
• Sensory - positive (pins & needles) and negative sensory phenomena (loss of sensation)
• Cerebellum - inco-ordination and unsteady gait.
• Brain Stem - diplopia, vertigo, nystagmus, dysarthria
• Optic Nerves - optic neuritis (blurred vision)
• Bladder and Bowel - incontinence
• Higher Functions - depression, poor concentration, forgetfulness, etc.
• Fatigue

Front 10

How are horizontal eye movements mediated?

Back 10

(Contralateral) Parapontine reticular formation -decussates-> MLF -> III nucleus -> III

VI nucleus -> III

Front 11

How do you diagnose MS?

Back 11

MRI -

Sensitivity = 81%
Specificity = 96%

Front 12

What is the Pulfrich effect?

Back 12

The Pulfrich effect is a psychophysical percept wherein lateral motion of an object in the
field of view is interpreted by the visual cortex as having a depth component, due to a relative
difference in signal timings between
the two eyes.

Front 13

What is Uhtoff's phenomenon?

Back 13

Temporary vision loss associated with temperature induced optic neuritis as a result of physical exercise.

Front 14

What is the role of oligoclonal IgG banding in MS diagnosis?

Back 14

Bands of IgG from serum/CSF - proteins from plasma cells.

Presence in CSF with absence in serum = IgG from CNS 80-90% MS patients have this.

Front 15

What are quantitative/qualitative tests for CSF OCBS?

Back 15

Quantitative: abnormal CSF barrier function - albumin quotient, IgG quotient, increased cell count

Qualitative: Agarose, acrylamide, IEF OCB

Front 16

What are the two types of MS?

Back 16

Relapse-remitting

Primary progressive

Front 17

What is baclofen?

Back 17

Antispasmodic. GABA analogue, inhibits mono + polysynpatic reflexes.

Front 18

What are possible disease modifying treatments for MS?

Back 18

– Acute Relapse - high dose corticosteroids
– Relapsing cases - interferon beta & glatiramer acetate
– Highly active cases – fingolimod, natalizumab, mitoxantrone
– Drugs in development – Teriflunomide, BG12, laquinimod, alemtuzumab, ocrelizumab, daclizumab
– Progressive cases – nothing licensed; need for effective neuroprotectants
– Prevention – strategies need to be tested
– Cure –early aggressive immune system rebooters have the greatest chance of a
cure

Front 19

What symptomatic care is needed for MS?

Back 19

– Spasticity (baclofen, etc.)
– Bladder and bowel function
– Fatigue
– Depression
– Infections
– Skin and foot care
– Pain
– Physiotherapy
– Occupational Care

Front 20

What are good prognostic features of MS?

Back 20

– young, female
– relapsing course
– optic neuritis or sensory onset
– long gap between first and second relapses.
– full recovery from initial attack
– low baseline lesion load on MRI