4.6 Multiple Sclerosis Flashcards
clinical features of MS 5
- depends on which area is demyelinated however:
- poor coordination
- muscle weakness
- changes to vision
- neuralgia
- heat insensitivity
greater in females or males MS
females
environmental risk factors 4 MS
smoking
decreased sun exposure
latitude - further from equator increased risk
viral infections particularly EBV + herpes
is MS due to a monogenic change or polygenic
polygenic
patho overview: ms
- trigger activating autoimmune t and be cells
- inflammation
- demyelination
- remyelination
- exhaustion
- neuronal death
4 patterns of pathology process ms
- demyelination in areas with macrophage infiltration
- t cell and macrophage induced inflammation
- changes in myelin protein expression and oligodendrocyte apoptosis
- degeneration and DNA fragmentation of oligodendrocytes
the four types of MS
relapsing remitting
primary progressive
secondary progressive
progressive relapsing
characteristics of relapsing remitting MS 2
majority of cases
increased disbability with acute attacks with periods of remission with no increased disability
characteristics of primary progressive MS
progressive disability over time with no remittance
characteristics of secondary progressive MS 2
often develops from relapsing remittent MS
remittance stops and develops into progressive form
progressive relapsing MS 2
periods of progression and then remittance
during periods of remittance disability still develops
Role of CD4 cells in MS 3
inflammation
BBB breakdown
activates b cells
role of CD8 cells in MS
cytotoxic to oligodendrocytes
role of b cells in MS
produce antibodies that react with myelin causing damage
investigations for MS 3
MRI with gadolinium
CF test for inflammation
neurophysiological tests which evoke potential to test for delays in conduction
what will an MRI w gadallidium show in MS 3
lesions
BBB breakdown
demyelinated plaques
what does CSF show when tested for MS 3
- igG antibodies
- oligoclonal bands
-leukocyte pleuocytosis
frontline Management of MS
corticosteroids
cytokine therapy
plasmophoresis
two drugs: not monoclonal antibodies
second line management of MS
monoclonal antibodies
third line treatment of monoclonal antibodies 3
- Alemtuzumab
- autologus hematopoeitic stem cell transplant
mitoxantrane = inhibit DNA synthesis
on the MRI for MS what is one key features taht you see?
Dawson’s fingers, these are projections perpednicular to the lateral ventricles they represent demyelinating plaques
optic neuritis
this is a common symptom of MS, it will present with changes to vision and pain upon movement.
can you get papiloedema in MS
yes
Mcdonald criteria for MS
Diagnostic criteria for MS based off two factors:
- evidence of lesions in multiple locations within the brain
- episodes of neurological symptoms at different points in time
