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Multiple sclerosis

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What are the most common clinical manifestations of multiple sclerosis?
Myelitis
Optic neuritis
Cranial nerve involvement
Cerebellar involvement
Epilepsy
Fatigue
Mood instability
Cognitive dysfunction
What is Lhermitte's sign?
Electric shock sensation triggered by neck movement
What is Uhthoff's phenomenon?
Worsening of MS symptoms when body is overheated
What type of visual field defect do you get in MS?
Central scotoma
What type of nystagmus do you get in MS?
Pendular nystagmus
Where is the lesion in inter-nuclear ophthalmoplegia?
Medial longitudinal fasciculus
What distribution of weakness does MS usually cause?
Legs>arms
Pyramidal pattern: hip flexion, knee flexion, dorsiflexion
What are the McDonald criteria for the diagnosis of MS?
Dissemination in space:
- one or more T2 lesions in the MS typical regions on MRI
- or second clinical attack affecting a different part of the CNS
Dissemination in time:
- seen on multiple MRIs, or simultaneous presence of gadolinium enhancing lesion and non-enhancing lesion on a single MRI
- second clinical attack
What are the 4 regions you typically see MS lesions on MRI?
Juxta-cortical
Peri-ventricular
Infratentorial (typically cerebellum)
Spinal cord
What are you looking for in the CSF of a patient you suspect has MS?
Oligoclonal bands
What % of patients with a clinically isolated syndrome and MRI lesions progress to multiple sclerosis?
60-80%
What % of patients with a clinically isolated syndrome but no MRI lesions progress to multiple sclerosis?
20%
What is the antibody which causes neuromyelitis optica?
anti-aquaporin 4
What is the only oral drug used in MS?
Fingolimod (gilenya)
What are the recombinant antibodies used in MS?
Nataluzimab
Alemtuzimab