20 - Multiple Sclerosis Flashcards
What is MS
Inflammatory demyelinating and degenerative chronic disease
MS characteristic?
Current/previous neurologic symptoms/episode
Lasting at least 24 hours without evidence of infection, fever or encephalopathy
Common symptoms
Sensory/motor - Numbness/tingling, electric sensation down the back of arms or legs, useless hand syndrome
Vision - Blurriness/loss or diplopia
Slow progressive or subacute motor deficits
Rarer symptoms
Bladder dysfunction
Heat intolerance
Dementia
What is relapse-remitting MS?
Most common, flare up and then return to normal
Secondary-progressive MS?
If no treatment, will first have relapse-remitting then progressing
Primary progressive MS?
Disease keeps progressing
MRI characteristics
T2/FLAIR lesions
Lesion in corpus callosum
What is used to enhance areas of inflammation?
Contrast Gadolinium
What are you looking for in a lumbar puncture
Neurofilaments (parts of the axons) in the CSF which shows nerve loss
Diagnostic criteria
o Damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves (Dissemination in space) AND
o Find evidence that the damage occurred at two different points in time (Dissemination in time ) AND
o Rule out all other possible diagnoses
Differential diagnosis for MS
Cerebrovascular disease Syphilis SLE Vasculitis B12 def
Genetics of MS?
•Higher chance if family member has MS
•30% of twin with MS (not that high)
HLA-DR2 gene
Causes of MS?
Do not know the specific cause
Viral, mitochondrial, excitotoxicity, aggregations, infections
What is the hallmark of MS?
• Axons which are present but without myelin
What will you see in an MS post mortem?
atrophy, plaques of neuronal loss all over
What sort of scar is formed in MS?
Astrocytic scar
1st line escalation drugs?
- Injectables: IFNb and GA
- Orals: DMF and Teriflunomide - More recent but more S.E
- Natalizumab (highly active)
1st line induction drugs?
- Alemtuzumab
- Mitoxantrone
- HSCT
2nd line drugs
Fingolimod
Natalizumab
Alemtuzumab
HSCT
