Case 6 - MS Lecture

Question 1

what is MS

Answer 1

acute localised and chronic diffuse, inflammation of the CNS and subsequent demyelination of neurones, following the infiltration of immune cells across the BBB

Question 2

pathophysiology of MS

Answer 2

Question 3

what is demyeliation

Answer 3

impulse is either delayed / variable or blocked

nerve may be sectioned or die which means permanent disability

Question 4

what is re myelination

Answer 4

variable.
patient may have constant or intermittent deficit. nerves prone to crosstalk/variable conductivity with temperature

Question 5

upper and lower motor neurone signs

Answer 5

Question 6

1 in what plaques causes symptoms

Answer 6

1 in 10 to 15

Question 7

what are the LP results from a patient with ms

Answer 7

CSF cell count: WCC <50 x 10 power of 6 / mL (normal)

CSF protein: <1g/ml - usually normal

CSF/serum glucose ratio: o.4

Question 8

what are evoked potentials

Answer 8

delayed in demyelination in the anterior visual pathways

Question 9

what are somatosensory evoked potentials

Answer 9

assess the posterior column of the spinal cord, the brainstem and cerebra cortex

Question 10

what is the McDonald Criteria

Answer 10

two different releases (space) at two different times (time)

Question 11

dissemination in space:

Answer 11

the development of lesions in distinct anatomical locations within the CNS i.e indicating a multifocal CNS process
- brainstem
- juxtacortical
- periventricular
- spinal cord

Question 12

dissemination in time:

Answer 12

development or appearance of new CNS lesions over time
positive oligoclonal bands

Question 13

McDonald 2017

Answer 13

Question 14

what is relapsing remitting MS

Answer 14

attacks with complete or partial recovery
no progression between attacks (remission)

Question 15

what is secondary progressive MS

Answer 15

initial relapsing remitting course followed by progression
with or without attacks

Question 16

what is primary progressive MS

Answer 16

progression from onset. no attacks

Question 17

what is progressive relapsing MS

Answer 17

progression from onset with attacks

Question 18

what is clinical relapse

Answer 18

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

Question 19

what is RRMS

Answer 19

mild
highly active: failing first line treatment
rapidly evolving severe: two or more releases in 12 months with radiological evidence of disease activity

Question 20

DMT injectable types of medication

Answer 20

Question 21

DMT oral treatments

Answer 21

Question 22

DMT mechanism of action

Answer 22

Question 23

DMTs safe in pregnancy

Answer 23

interferons
glatiramer
natalizumab