Case 6 - MS Lecture Flashcards
what is MS
acute localised and chronic diffuse, inflammation of the CNS and subsequent demyelination of neurones, following the infiltration of immune cells across the BBB
pathophysiology of MS
what is demyeliation
impulse is either delayed / variable or blocked
nerve may be sectioned or die which means permanent disability
what is re myelination
variable.
patient may have constant or intermittent deficit. nerves prone to crosstalk/variable conductivity with temperature
upper and lower motor neurone signs
1 in what plaques causes symptoms
1 in 10 to 15
what are the LP results from a patient with ms
CSF cell count: WCC <50 x 10 power of 6 / mL (normal)
CSF protein: <1g/ml - usually normal
CSF/serum glucose ratio: o.4
what are evoked potentials
delayed in demyelination in the anterior visual pathways
what are somatosensory evoked potentials
assess the posterior column of the spinal cord, the brainstem and cerebra cortex
what is the McDonald Criteria
two different releases (space) at two different times (time)
dissemination in space:
the development of lesions in distinct anatomical locations within the CNS i.e indicating a multifocal CNS process
- brainstem
- juxtacortical
- periventricular
- spinal cord
dissemination in time:
development or appearance of new CNS lesions over time
positive oligoclonal bands
McDonald 2017
what is relapsing remitting MS
attacks with complete or partial recovery
no progression between attacks (remission)
what is secondary progressive MS
initial relapsing remitting course followed by progression
with or without attacks
what is primary progressive MS
progression from onset. no attacks
what is progressive relapsing MS
progression from onset with attacks
what is clinical relapse
patient reported symptoms or objectively observed signs typical of an acute inflammatory demyelinating event in the CNS, current or historical with duration of at least 24 hours in the absence of fever or infection
what is RRMS
mild
highly active: failing first line treatment
rapidly evolving severe: two or more releases in 12 months with radiological evidence of disease activity
DMT injectable types of medication
DMT oral treatments
DMT mechanism of action
DMTs safe in pregnancy
interferons
glatiramer
natalizumab
