PassMED: Medical Finals Examination Revision

Multiple Sclerosis

Signs	Spastic paraparesis, cerebellar signs ± optic atrophy in young female
Differential diagnosis	Demyelinating disease
Tests	Vitamin B12 to exclude subacute degeneration MR brain - hyperintense focal perventricular white matter lesions on T2 weighted Lumbar puncture - raised total protein, oligoclonal bands Serum electrophoresis - to exclude oligoclonal bands in serum

Common presentations: Optic neuritis, limb weakness, nystagmus
Categories: Relapsing-remitting; secondary progressive; primary progressive; progressive relapsing
Poor prognosis: progressive disease, multiple lesions on MR, freqeunt relapses first 2 years
IV methylpred given to speed recovery in relapses, however no evidence for long term benefit.
Interferon beta (1a/1b) reduces the relapse rate in relapsing/remitting by one third. Indicated for ambulant patients with at least 2 relapses in previous 2 years with recovery.