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What is the pathophysiology of multiple sclerosis

acquired chronic immune mediated inflammatory condition of the CNS.
autoimmune destruction of oligodendrocytes by T cells
gliosis - scarring
neuronal damage leading to cell loss


What are the different types of MS

relapsing remitting
secondary progressive
primary progressive


Describe the course of relapsing remitting MS

symptoms come and go. Periods of good health or remission are followed by sudden symptoms or relapses


Describe the course of secondary progressive MS

the onset of MS is of the RRMS pattern. But, at some point later, the disease course changes and neurological function gradually worsens, with or without continued relapses.


Describe the course of primary progressive MS

from the beginning, symptoms gradually develop and worsen over time


Define a relapse in MS

onset of new or worsening of current symptoms
attributable to demyelinating disease
>24hr onset
absence of infection, fever, metabolic disturbance


What are the most common presentations of MS

optic neuritis - partial or total unilateral visual loss, pain on movement, dereased visual acuity, decreased colour sensitivity

transverse myelitis - paresthesia or weakness below level of inflammation

cerebellar problems - ataxia, vertigo, clumsiness, dysmetria

brain stem problems - ataxia, abnormal eye movements, dysphagia


What is Lhermitte’s phenomena

shock like sensation radiating down the spine induced by neck flexion


Give some differentials for MS

neuromyelitis optica
low vit B12
Lyme disease
tertiary syphilis
brain neoplasm


What is the key diagnostic investigation in MS

MRI head - periventricular lesions and discrete white matter abnormalities


What is the treatment for a relapse of MS

IV or oral steroids - metyhlprednisolone for 5 days


What is the treatment long term for MS

DMARDs - eg. interferon beta
management of long term problems of fatigue, pain etc


What causes a seizure

neurons synchronously depolarising due to increased excitation or decreased inhibition


What are the main excitatory and inhibitory neurotransmitters in the brain

excitatory: NMDA
inhibitory: GABA


Define seizure

transient occurrence of signs and symptoms due to abnormal electrical activity in the brain


What is the difference between a partial seizure and a generalised seizure

partial - only part of the brain is affected
generalised - both hemispheres affected


What is the difference between a simple partial seizure and a complex partial seizure

partial - no loss of consciousness, remember what happened

complex - partial or complete loss of consciousness, may not remember it


What is a secondary generalised seizure

started as partial, becomes generalised


What happens in a tonic seizure

become stiff, flexed. fall backwards


What happens in an atonic seizure

become relaxed, complete loss of tone, fall forwards


What happens in a clonic seizure



What happens in a tonic-clonic seizure

increased tone and convulsions


What happens in a myoclonic seizure

short muscle twitches


What happens in an absence seizure

lose and regain consciousness, zones out


What is a Jacksonian march

seizure starts in small area eg hand, then spread to larger eg arm. Can become generalized


What are some of the signs or symptoms of post-ictal period

Drowsiness or amnesia.
Injury, including bites to the sides of the tongue.
Aching limbs or headache.
Focal neurological deficit, that slowly recovers.


What is Todd's paralysis

a focal neurological deficit, most commonly weakness, that occurs after a seizure
fully recovers after 48 hours


How is epilepsy defined

At least two unprovoked seizures occurring more than 24 hours apart.

One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years.

Diagnosis of an epilepsy syndrome — there are at least 30 different epilepsy syndromes distinguished by their seizure type, age of onset, family history, neurological findings, cerebral imaging (such as CT or MRI scan), electroencephalogram (EEG) pattern, and underlying cause.


What are the causes of epilepsy

cerebrovascular disease
cerebral tumour
post traumatic
fetal hypoxia or trauma
cortical or vascular malformation
cerebral abscess
epilepsy syndromes


What are the differential diagnoses for a seizure
What would help you rule these in/out

syncope - postural change, pale. Feel faint/lightheaded beforehand, blurred vision, ringing ears

arrhythmia - prev IHD/SHD, palpitation, breathless, CP

hyperventilation of anxiety - fear, breathless, paresthesia

febrile convulsions - temp >37.8, 6m-5y

alcohol withdrawal - known alcoholic, around 36 hours following cessation of drinking

infantile spasms - flexion of head, trunk and limbs, extension of arms

Psychogenic non-epileptic seizures - history of mental health problems or a personality disorder