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Neuro DRx > 04a: MS and Movement > Flashcards

04a: MS and Movement Flashcards

1
Q

MS is a disease of (X) cells, causing (central/peripheral) de-myelination.

A

X = oligodendrocytes

Central only! (doesn’t affect Schwann cells)

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2
Q

Role of (X) supplementation and deficiency has been found to play a role in MS.

A

X = vitamin D

Vit D supplementation prevents and slows the progression of the
disease, while deficiency worsens the disease

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3
Q

Migration studies support the view that there is (X) trigger is in the pathogenesis of MS.

A

X = environmental (low risk in Japan and almost no cases in Inuit populations)

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4
Q

List the 4 MS phenotypes and star the one seen most commonly at onset of MS in patient.

A
  1. Pure relapsing-remitting (RRMS)* (85%)
  2. Secondary-progressive (SPMS)
  3. Primary-progressive (PPMS; 10%)
  4. Progressive relapsing (PRMS; 5%)
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5
Q

(X) phenotype of MS develops in many patients that initially had pure relapsing-remitting (RRMS).

A

X = secondary-progressive (SPMS)

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6
Q

What’s characterized as benign MS?

A

No progression for 15 y

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7
Q

What’s Clinically Isolated Syndrome (CIS)?

A

One neurological episode

or “relapse” of MS

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8
Q

List three clinical symptoms of visual pathways seen in MS relapse.

A
  1. Diplopia (INO or CN 3, 4, 6 issue)
  2. Optic neuritis (painful movement, vision affected)
  3. Nystagmus
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9
Q

MS clinical symptom: Localized SC inflammation that involves the full thickness of the cord and produces symptoms related to the sensory/motor innervation at that level.

A

Transverse myelitis

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10
Q

MS diagnosis is based on either (X) or (Y).

A 
X = Multiple white matter lesions separated in time and space (relapsing disease)
Y = Progressive disease from onset with typical clinical findings
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11
Q

McDonald criteria for (X) findings in (Y) disease.

A 
X = dissemination in time and space of lesions
Y = MS
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12
Q

MS: list the ways that MRI lesions meet McDonal criteria for “disseminated in time”

A
  1. Both enhancing and non-enhancing lesions in same MRI OR

2. Appearance of new lesions after initial MRI

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13
Q

MS: list the ways that MRI lesions meet McDonal criteria for “disseminated in space”

A

At least one T2 lesion in 2 out of the 4 typical locations for MS

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14
Q

List the four typical locations for lesions in MS.

A
  1. Periventricular
  2. Juxtacortical
  3. Infratentorial
  4. SC
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15
Q

T/F: There are no definitive laboratory test or MRI features for MS.

A

True - other diseases can mimic MS (consider alternative diagnoses, even after making MS diagnosis)

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16
Q

Progressive MS diagnosis: (X) year(s) of disease progression plus 2/3 of which criteria?

A

X = 1

  1. Lesions disseminated in space in brain
  2. Lesions disseminated in space in SC
  3. Oligoclonal bands in in CSF
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17
Q

Neuromyelitis Optica (NMO) was initially thought to be part of (X) disease, but is now considered distinct. What are the symptoms?

A

X = MS

Optic neuritis and transverse myelitis

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18
Q

T/F: Neuromyelitis Optica has better prognosis than MS.

A

False

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19
Q

(X) Ab in (serum/CSF) is seen in 80% of patients with Neuromyelitis Optica (NMO)

A

X = Aquaporin-4

Serum or CSF

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20
Q

List some clinical symptoms that can act as hints for Neuromyelitis Optica.

A
  1. Poor visual recovery
  2. Bilateral optical neuritis
  3. Transverse myelitis
  4. Hiccups, N/V (area postrema affected)
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21
Q

List two “injectable” disease-modifying drugs for MS that have been around for over 20 y. These are administered via which route?

A
  1. IFN-beta (IM, SC)

2. Glatiramer acetate (SC)

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22
Q

What is the mechanism of the disease-modifying drugs for MS (IFN-beta, Glatiramer acetate).

A

Th1 (bad) to Th2 (good) shift

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23
Q

List some oral disease-modifying drugs for MS.

A
  1. Fingolimod
  2. Teriflunomide
  3. Dimethyl Fumarate
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24
Q

MS medication: Fingolimod MOA

A

Sphingosine R blocker (inhibits T cell migration from lymph nodes)

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25
(X) drug improves walking speed in 30-40% of patients with MS.
X = Dalfampridine
26
Tremor that improves with EtOH.
Essential tremor
27
Most common movement disorder.
Essential tremor
28
Essential tremor (present/absent) at rest and (present/absent) during action. Family Hx positive in (X)% of patients.
Absent; present | X = 50 (AD)
29
Essential tremor has been correlated to activity in (X) parts of brain.
X = sensorimotor area and cerebellum
30
Essential tremor: more (symmetric/asymmetric) than the tremor of PD. (X) key PD symptoms are not seen in this tremor.
Symmetric; X = bradykinesia and rigidity
31
Essential tremor: usually involves (upper/lower) limbs in addition to:
Upper Head (no-no) and voice
32
Essential tremor: which two meds mainly used (solo or in combo).
1. Primidone (old antiepileptic) | 2. Propranolol
33
The target for the treatment of essential tremor with Deep Brain Stimulation is the (X).
X = ventrointermediate | nucleus (VIM) of the thalamus
34
Parkinsonism comprised of which constellation of signs on PE?
1. Rigidity 2. Bradykinesia (slow mvmt) 3. Gait abnormalities/postural instability 4. Tremor
35
Difference between Parkinsonism and PD.
PD is Parkinsonism with no known cause
36
Parkinsonism can have which etiologies?
1. Drug/med or toxic cause 2. Vascular 3. Post-traumatic 4. NPH (Normal P hydrocephalus)
37
Mean survival in PD after onset is (X) years and most common causes are:
X = 20+ pulmonary infection/aspiration, and complications of falls
38
PD: CT/MRI show (X) abnormalities and SPET/PET show (symmetric/asymmetric) (Y) abnormalities.
X = no Asymmetric Y = decrease dopamine levels
39
DaTscan used to detect:
Dopamine transporters | (DaT) in the brain
40
Risk Factors for PD:
1. Age 2. Genetics 3. Environmental (toxic products, well water, repeated head injury)
41
Alien hand syndrome can occur in (X), which is one of the (Y) Syndromes.
``` X = Corticobasal degeneration Y = Parkinson Plus ```
42
Corticobasal degeneration has (symmetric/asymmetric) onset with (slow/rapid) clinical course and (X) changes on CT/MRI.
Asymmetric; Rapid (5-10y) X = contralateral atrophy
43
Corticobasal degeneration: PET may show (increased/decreased) contralateral fluorodopa uptake in (X) parts of brain.
Decrease | X = basal ganglia and association cortices
44
T/F: Parkinson Plus Syndromes respond to PD drugs.
False
45
T/F: Parkinson Plus Syndrome pathology involves Tau protein
True
46
Parkinson plus syndrome with gait disturbance and frequent falls:
Progressive Supranuclear Palsy (PSP)
47
T/F: Neuro manifestations of Wilson's includes tremor.
True - wing-beating
48
Wilson's: (high/low) ceruloplasmin, and (high/low) urinary copper levels.
Low; high
49
Slit lamp examination revealing Kayser-Fleischer rings is indicative of (X) disease.
X = Wilson's
50
MRI in Wilson's often shows abnormal (T1/T2) signaling in (X) part of brain.
T2 | X = basal ganglia
51
Medical therapies for Wilson's include:
1. Reducing copper in the diet 2. Rx with zinc, penicillamine, or trientene 3. Liver transplant
52
Huntington's: (X) inheritence with gene on chromosome (Y). What's the trinucleotide repeat sequence?
``` X = AD Y = 4 ``` CAG
53
Huntington's: Imaging studies reveal ...
Atrophy of caudate and putamen
54
Which meds can be used to treat Huntington's chorea?
1. Dopamine antagonists (haloperidol, risperidone, olanzapine) 2. Benzos may help 3. Tetrabenazine (suppresses chorea)
55
What's ataxia?
Lack of coordination while performing voluntary movements (may appear as clumsiness, inaccuracy, or instability)
56
Ataxia usually caused by damage to the (X).
X = cerebellum (inputs/outputs)
57
Rx for ataxia:
Treat underlying cause; supportive therapy
58
Rx for myoclonus
Removing the offending agent, and considering treatment | with an antiepileptic (valproate), or a benzodiazepine
59
Cornerstone of symptomatic | management of PD that replaces (X) (pre/post)-synaptically.
Carbidopa/levadopa X = DA Pre-synaptically
60
PD treatment: DA receptor (agonist/antagonist) that acts directly on (pre/post)-synaptic receptors.
Pramipexole Agonst; post-synaptic
61
(X) PD drug is COMT, aka (Y), (stimulator/inhibitor) that increases amount of (Z) available
X = entocapone Y = Catechol O-methyl transferase Inhibitor Z = levodopa
62
(X) PD drug is MOA-B (stimulator/inhibitor) that increases amount of (Y) available
X = Rasalagine Inhibitor Y = dopamine
63
Carbidopa is added to levodopa to:
decrease the | nausea
64
Levodopa side effects:
N/V, dyskinesias (late side effect)
65
(Levodopa/Pramipexole) does not compete with protein in food and can be taken at any time.
Pramipexole (DA agonist)
66
Pramipexole side effects:
Drowsiness (sleep attacks); | Others: HA, confusion, compulsions, hallucinations and paranoia
67
Entacapone should be used in combo with (X) to be effective.
X = levodopa | since it's a COMT inhibitor
68
Side effects of Entacapone:
Diarrhea, abdominal pain, urine discoloration, liver function changes
69
Side effects of Rasaligine:
HA, nausea, HT arthralgia, dyskinesias, hallucinations
70
(X) drug was introduced as an antiviral agent and reported | useful in PD in 1969. What's its MOA?
X = amantadine DA reuptake blockade activity, anticholinergic action and blockade of NMDA receptors
71
Side effects of amantadine:
Confusion, hallucinations
72
Anticholinergic drug occasionally (now rarely) used for the treatment of PD:
Trihexyphenidyl HCl
73
Writing or dancing movements that patients may experience after they have been on dopaminergic medications for 5+ years
Dyskinesias (considered "ON" behavior and may not troublesome to patient)

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