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myelopathy
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- 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
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- 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
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- 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
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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
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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)
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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
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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
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which drugs are used to control cerebellar tremor?
- clonazepam
- isoniazid with pyridoxine
- gabapentin
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which drugs are used to control fatigue?
- amantadine
- selegiline
- modafinil: anti narcolepsy drug
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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
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which drugs are used to control depression?
- TCA amitriptyline
- SSRI: sertraline
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which drugs are used to control erectile impotence?
- PDE5 inhibitors
- sildenafil
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which drugs are used to control pain, paroxysmal symptoms inc seizures?
- carbamazepine
- gabapentine
- amitriptyline
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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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