8: Advances in Multiple Sclerosis - Hughes

Question 1

multiple sclerosis only gives you…

Answer 1

UMN findings

Question 2

describe MS

Answer 2

• episodes of focal disorder of the CNS
• demyelinating AND axonal disease
• white matter predominant but also affects grey matter
• autoimmune disease

Question 3

which virus has been implicated in MS?

Answer 3

EBV

titers present in almost all MS pts and levels are increased during acute MS attacks

Question 4

I have MS. Are my kids going to get it?

Answer 4

1/40 chance

concordance rate of 30% in monozygotic twins

Question 5

immunology of MS

Answer 5

• predominantly aberrant Tcell immune response ( B cells and macrophages also play role)
• dysfunction in BBB allowing the activated cells to cross into the CNS attacking myelin

Question 6

85% of MS patients start with…

Answer 6

relapsing-remitting MS

some start with primary progressive

secondary progressive from the relapsing remitting

Question 7

poor prognostic indicators for MS

Answer 7

• male
• older age at onset
• posterior fossa symptoms at onset
• African American
• Significant residual disability from first attack

Question 8

spots in the corpus callosum =

Answer 8

highly suspicious of MS (demyelinating)

Question 9

what in a CSF exam would indicated MS?

Answer 9

• presence of oligoclonal IgG bands
• elevated IgG synthesis rate
• nonspecific elevation in prtn
• pleocytosis of typically less than 50 wbc and only very rarely above 100

Question 10

VER visual evoked response

Answer 10

MS has a slower response

most helpful evoked potential test

Question 11

describe neuromyelitis optica aka Devic’s disease

Answer 11

• demyelinating disease of CNS
• purely B cell driven disease
• associated with aquaporin 4
• blind and quadraplegic with intact brain

Question 12

describe Disseminated encephalomyelitis

Answer 12

• pediatric greater than adult
• febrile illness
• grey and white matter
• monophasic (one attack- cognitive issues, seizure,

Question 13

only FDA approved drug for improved walking speed in MS patients

Answer 13

fampridine

K channel blocker - improves conductivity in demyelinated nerves

Question 14

what supplements might a MS be taking?

Answer 14

• Vit D ( only recommended supplement - impacts immune system, also good for osteoporosis)

Question 15

immune modulators used in treatment of MS

Answer 15

• beta interferon
• glatiramer acetate
• mitozantrone
• natalizumab, alemtuzumab
• fingolimod

Question 16

first drug that is efficacious in primary progressive MS

Answer 16

ocralizamab