B2W3 Trans Phys Multiple Sclerosis

Question 1

Multiple Sclerosis

Answer 1

Inflammatory neurodegenerative disease of the central nervous system.

Unknown cause but there appears to be risk factors and genetic predispositions

Question 2

Target of MS autoimmune response

Answer 2

Oligodendrocytes

Question 3

Three Main Glial Cells

Answer 3

Oligodendrocytes, Astrocytes, and Microglia

Question 4

Oligodendrocytes

Answer 4

Provide insulation and support to neurons of the CNS through the creation of myelin.

One oligodendrocyte can bind to upwards of 50 axons

Question 5

Astrocytes

Answer 5

Biochemical support of endothelial cells. Maintains the BBB provides nutrients and repairs damage.

Question 6

Microglia

Answer 6

Macrophages of the brain and spinal cord. Get rid of damaged neurons and infectious agents

Question 7

Onset of MS

Answer 7

Ages 20-50
2-3x more common in women

Question 8

Stages of MS

Answer 8

RIS (Radiologically Isolated Syndrome), Preclinical, CIS (Clinical Isolated Syndrome), Relapsing and Remitting, and Secondary Progressive

Question 9

RIS Radiologically Isolated Syndrome

Answer 9

Signs of MS in scans but no physical symptoms present

Question 10

CIS Clinical Isolated Syndrome

Answer 10

First appearance of MS symptoms

End of Preclinical phase

Question 11

Relapsing-Remitting

Answer 11

Cycle of periods of high MS disability and periods of low MS disability but with a general trend towards higher disability. Highest point of inflammation

Question 12

Secondary Progressive

Answer 12

No more relapses in disability. Overall result in a decrease in brain volume and axon loss

Question 13

Risk Factors of MS

Answer 13

Epstein-Barr Virus (Mono), Smoking, Low Vitamin D, Obesity, and genetic mutations of the human leukocyte antigen

Question 14

Immunology of MS

Answer 14

Regulatory T cells maintain a balance of inflammatory and anti-inflammatory factors. In MS Regulatory T cells malfunction and upregulate pro-inflammatory factors TH1/TH17.

Inflammation disrupts the BBB and allows for the entrance and maturation of B Cells in the CNS

Question 15

B Cells in MS

Answer 15

B Cells are antigens to T cells triggering the immune response of T Cells, produce antibodies that activate macrophages and NK cells, can form aggregates in the meninges, and produces proinflammatory cytokines

B cells are not usually found within the CSF but are in MS patients

Question 16

Pathologic Hallmark of MS

Answer 16

Alterations of the BBB, inflammation, demyelination, axonal degeneration, neuronal loss, and gliosis

Question 17

Active MS Lesions

Answer 17

Macrophages contain myelin debris and lymphocytes infiltrate through gaps in the BBB

Question 18

Gliosis

Answer 18

Over production of large glial cells

Question 19

Relapse-Remitting Multiple Sclerosis

Answer 19

80-85% of patients have MS which has periods of high and low disability followed by a secondary progressive phase where disability continues to increase

Question 20

Primary Progressive Multiple Sclerosis

Answer 20

10-15% of patients have a continual worsening of MS symptoms and disability without periods of remitting

Question 21

Role of Gray and White Matter

Answer 21

MS is both a disease of the white and gray matter, and gray matter (demyelinating)
lesions are known to occur early in the disease
Inflammation, demyelination and neurodegeneration, typical of white matter
involvement in MS, are seen also in the gray matter
Gray matter atrophy is a major component of MS pathobiology and correlates with
clinical disability better than damage to the white matter

Question 22

MS Relapse

Answer 22

Patient reported or observed symptoms that last 24 hours or more

Question 23

Two Diagnostic Criteria for MS

Answer 23

Dissemination in Space
Dissemination in Time

Question 24

Dissemination in Space

Answer 24

Signs of MS in different and unrelated places as shown on an MRI

Question 25

Dissemination in Time

Answer 25

Shown symptoms or lesions that have occurred at two different and unrelated times

Question 26

RRMS Clinical Criteria

Answer 26

Multiple attacks in multiple areas

Question 27

RRMS MRI Criteria

Answer 27

Simultaneous enhancing and non-enhancing lesions

Presence of CSF Oligoclonal Bands

Question 28

PPMS Diagnostic Criteria

Answer 28

1 year of disease progression

1 or more T2 lesions 2 or more T2 spinal cord lesions

Presence of CSF Oligoclonal Bands

Question 29

Enhancing Lesions

Answer 29

Gadolinium enhancing cause bright spots indicating currently active inflammation and acute BBB damage

Question 30

Non-Enhancing Lesion

Answer 30

T1 and T2 Lesion do not react to gadolinium showing up as dark spots on an MRI indication prior inflammation as well as loss of myelin and axonal atrophy

Question 31

Neuromyelitis Optica (NMO) Spectrum Disorder

Answer 31

A demyelinating disorder that differs from MS as the main target of the autoimmune response is the astrocytes.

Question 32

Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Disease

Answer 32

Demyelinating disease that targets oligodendrocytes but is characterized by primarily optical symptoms that can be monophasic or relapse

Question 33

MS Differences (MS Vs. NMO vs. MOG)

Answer 33

MS
- Most Common
- Target Myelin
- Good Recovery after attack
- Optic Nerve MRI
- - Unilateral
- - Middle of Optic Nerve

Question 34

NMO Differences (MS Vs. NMO vs. MOG)

Answer 34

NMO
- Rare
- Target Astrocytes
- Poor recovery after attacks
- Optic Nerve MRI
- - Bilateral
- - Posterior optic nerve that leads to optic chiasm

Question 35

MOG Differences (MS Vs. NMO vs. MOG)

Answer 35

MOG
- Unknown rarity
- Target Oligodendrocytes
- Good recovery after attacks
- Optic Nerve MRI
- - Bilateral
- - Nerve affected anteriorly