1. myelopathy
    • what is DD if has only motor signs and no sensory?
    • MND - distinguish as it also has LMN signs with MS doesnt
    • other name for MND is amyotrophic lateral sclerosis
    • what is DD for brainstem syndromes
    • tumours
    • BS encephalitis
    • cranial polyneuritis
    • arnold-chiari malformation: downward displacements of cerebellar tonsils through foramen magnum
    • vascular disease
    • MRI and CSF can distinguish
    • what is it called when there is a monophasic illness characterised by widespread multifocal demyelination in isolation? how can tell difference between MS?
    • acute disseminated encephalomyelitis
    • of after infection: post infectious encephalomyelitis
    • Multiple ares of demyelination separated in space BUT NOT IN TIME
  2. how are acute relapses of MS treated?
    • if severe enough to limit function eg due to limb weakness or visual failure then treat with high dose iv or oral methylprednisolone 500mg-1g
    • for 3-5 days
    • must exclude UTI before starting steroids
  3. which 2 drugs are used to reduce the rate of progression and relapses of MS? and SE
    • interferon beta: SE flu like symptoms, CI in pregnancy
    • glatiramer: fewer SE but worse ISR (injection site reactions)
  4. which newer drug is twice as effective as glatiramer? what type of drug? SE?
    • monoclonal antibody natalizumab against integrin adhesion molecule
    • SE: PML - progressive multifocal leucoencephalopathy
    • alternative: mitoxantrone - anthracycline derivative but SE cardiotoxicity, acute leukaemia
  5. which drugs are used to control spasticity, flexor spasms? what is SE?
    • baclofen: sedative at high dose
    • dantrolene (use in NMS too due to rigidity)
    • diazepam
    • SE: weakness, drowsy
    • inject botox into affected muscles
    • cannabinoids - sativex
    • PHYSIO! - stretch exercises
  6. which drugs are used to control cerebellar tremor?
    • clonazepam
    • isoniazid with pyridoxine
    • gabapentin
  7. which drugs are used to control fatigue?
    • amantadine
    • selegiline
    • modafinil: anti narcolepsy drug
  8. which drugs are used to control bladder disturbances?
    • anticholinergic: oxybutinin or tolterodine or solifenacin
    • relax detrusor muscle
    • intermittent self catheterisation if post micturition bladder RV > 100ml
  9. which drugs are used to control depression?
    • TCA amitriptyline
    • SSRI: sertraline
  10. which drugs are used to control erectile impotence?
    • PDE5 inhibitors
    • sildenafil
  11. which drugs are used to control pain, paroxysmal symptoms inc seizures?
    • carbamazepine
    • gabapentine
    • amitriptyline
  12. which drugs are used to control constipation?
    • bulking agents: eg fybogel - ispaghula husk
    • stool softeners: eg docusate
    • senna
    • movicol - polyethylene glycol
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