[ Neuromedicine ] Multiple sclerosis 3

Primary progressive MS (McDonald) – 2 or more of these after 1 year of disability

1 or more T2-hyperintense brain lesions, 2 or more T2-hyperintense spinal cord lesions, and oligoclonal bands.

MS MRI – most sensitive techniques

T2 and FLAIR.

MS MRI – enhancement

Seen with active lesions.

MS MRI – chronic disease finding

Atrophy.

MS plaques on MRI – most common location

Periventricular (Dawson's fingers).

MS plaques on MRI – other famous locations

Juxtacortical, cortical, infratentorial, and spinal.

MS CSF – white cells

Increased WBC (lymphocytes), usually less than 20, rarely more than 50 to 100.

MS CSF – protein

Mildly elevated (45 to 60).

MS CSF – best indicator

Oligoclonal bands on electrophoresis.

MS relapse (abortive) treatment

IV steroids (IV methylprednisolone), slam and taper (high dose then slow taper).

MS disease modifying therapy – purpose

Relapse prevention (maintenance).

MS spasticity – treatment

Baclofen and dantrolene (muscle relaxants).

MS fatigue – treatment

Amantadine or pemoline.

MS depression – treatment

SSRI.

MS prognosis – age of onset

Early onset is favorable, later onset is unfavorable.

MS prognosis – sex

Female is favorable, male is unfavorable.

MS prognosis – onset of symptoms

Acute onset is favorable, chronic onset is unfavorable.

MS prognosis – minimal dysfunction at 5 years

Favorable, it predicts minimal dysfunction at 15 years.

MS prognosis – presenting episode

Optic neuritis or sensory symptoms are favorable, spinal cord lesions are unfavorable.

Neuromyelitis optica spectrum disorder (NMOSD) – key finding

Positive antibodies to aquaporin 4 channels (IgG-AQP4).