Multiple Sclerosis

Front 1

MS - DEFINITION

Back 1

Multiple episodes of CNS dysfunction separated in time and space

Cannot be due to anything else

2 attacks needed for diagnosis

Front 2

MS - PATTERNS

Back 2

Relapsing Remitting - can move to benign or secondary progressive (deterioration between episodes)

Primary Progressive

PRMS - primary but with some relapses

Front 3

OPTIC NEURITIS

Back 3

Visual changes, pain on eye movement and swollen optic disc

Can lead to atrophy

Good prognosis for sight

Front 4

TRANSVERSE MYELITIS

Back 4

Spinal cord inflammation

UMN weakness below level and numbness at level; also sphincter disturbances if involved

Front 5

BRAINSTEM ATTACKS

Back 5

Diplopia, ataxia, dysphagia, palsies, vertigo etc

Internuclear Opthalmoplegia: on lateral movement abducting eye has nystagmus and adducting eye lags behind

Front 6

MS - PAROXYSMAL SYMPTOMS

Back 6

TGN

Tonic spasms

Epilepsy

Front 7

LHERMITTE'S

Back 7

Waves of parasthaesiae in limbs when stretched due to spinal cord scarring

Front 8

UTHOFF'S

Back 8

Visual problems with increased body temperature due to previous optic neuritis

Front 9

MS - MANAGEMENT

Back 9

Aims to reduce early inflammation and regression; in relapses do nothing or give steroids

1) Interferons; flu, capillary leak syndrome

2) Teriflunomide; not in pregnancy; HZV infections

3) Dimethyl fumarate; cytotoxic

4) "mabs"; potential cure but cause autoimmune diseases