12: Multiple Sclerosis

Question 0

MS- info

Answer 0

Demyelination in CNS- periventricular area, spinal cord

1: Genetic predisposition- (6p21)
2: Environmental factor- (virus: Measles, Polio, Herpes 6)-> Geographic distributions (away from equator. Highest at Orkney island near scottland), Migration study (before age of 15, if you move to high risk area, you inherit the risk rate, after 15, you dont)**
3: Immunologic factor- damaging oligodendrocyte, cellular and humoral immune system both attack, IL-1, IL-2,

Question 1

MS- intro

Answer 1

Young female, Cocasian
Family history
Problem keeps changing- delay in diagnosis

Question 2

MS- sx

Answer 2

Changing sx
Optic neuritis- blurry vision, retroorbital pain
Color vision defect, Flushing light in front of eye
Fatigue, Weakness
Parastegia (reduced sensation) or (abnormal sensation)
UML- spasticity
Bladder/Bowel dysfunction (cannot initiate or urgency)
Cognitive issues
Depression
Trigeminal neuralgia
Facial muscle contraction
Band around the waist
Gait disorder
Pain
Ataxia

Question 3

MS- signs*

Answer 3

Lhermitt’s sign (electric shock as pt bend their neck)

Uhthoff’s sign (intolerance to heat: sx comes back with hot shower-> heat decreases conductance))

Question 4

MS- types

Answer 4

1: Relapsing Remitting (RRMS) (80-85%)
2: Secondary Progressive (after 7-10yrs, RRMS becomes progressive-> due to accumulated damage to axon)
3: Primary Progressive
4: Relapsing Progressive

Question 5

MS- dx

Answer 5

1: MRI* (blocks or blacks at white matter, Periventricular Dawson’s fingers)
2: CSF electrophoresis-> oligoclonal band more than 2 (Ab build up)
3: Evoked Potential: squeeze gets weaker

At least 2 episodes with 2 lesions

Question 6

MS- tx

Answer 6

Immunomodulating drugs
A: IFN-beta1a
B: IFN-beta1b
C: Glatiramer aceate
Natalizumab

Acute exacerbation: Glucocorticoids