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C2 Modules CLINICAL > Clinical forms of MS > Flashcards

Clinical forms of MS Flashcards

1
Q

What are the Multiple Sclerosis Epidemiology?

A
  1. About 1 in 800 people in the UK have MS
  2. About 100,000 people in UK have MS
  3. It goes on for decades
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2
Q

What are the clinical features of MS?

A
  1. Weakness
  2. Altered sensation
    - Numbness
    - Pain
    - Band-like sensation around torso (cord lesions)
    - Lhermitte’s (cervical cord lesions)
    - Sensation of water running down the back of their neck
    - Sensory disturbance/visual problems
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3
Q

What is the Expanded Disability Status Scale?

A
  1. 10 point scale
  2. Biggest critique: it mostly affects patient’s ability to walk
  3. 0 = no disability, 10= death due to MS
  4. Cognition only contributes to scores below 4
  5. Mostly based on ability to walk
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4
Q

What is not strongly correlated with physical disability?

A

Cognitive impairment

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5
Q

What do 40-70% of people with MS have?

A

Cognitive impairment
Occurs early:
- Detectable following a clinically isolated syndrome

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6
Q

What are the cognitive deficit of Multiple Sclerosis?

A
  1. More marked in people with progressive disease

2. Not closely linked with neurological impairments

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7
Q

What are the clinically forms of MS?

A
  1. Relapsing remitting MS
  2. Secondary progressive MS
  3. Primary progressive MS
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8
Q

What is Relapsing remitting MS?

A
  1. Clearly defined relapses with full or partial recovery

2. No progression between relapses

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9
Q

What is secondary progressive MS?

A
  1. Follows RR MS

2. Progression with or without occassional relapses

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10
Q

What is primary progressive MS?

A
  1. Progression from onset

2. Occasional plateaus or minor improvements

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11
Q

What is relapsing remitting MS characterised initially by?

A

Episodes of neurological dysfunction
Last for at least 24 hours

People should not have change in their neurologcal function

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12
Q

What do people with secondary progressive MS note?

A

Neurological dysfunction increasing over time

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13
Q

What are the problems with clinical features of MS?

A
  1. Bias in research
  2. Relapses and remissions
    - About 85% initially
  3. Progressive:
    - About 15%
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14
Q

What is the percentage of people with relapsing remitting MS will develop the secondary progression?

A

Eventually about 80%

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15
Q

What is benign MS?

A

Someone who has had multiple sclerosis for 10-15 years with low level of disability

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16
Q

What is the pathology of the multiple sclerosis?

A
  1. Inflammatory demyelination condition of white matter
  2. Evolves over time and so it is not a static process
  3. Multiple pathological processes that have different relevance at different stages of the disease
  4. Not just white matter
  5. Not just demyelination
  6. Dynamic
  7. Different processes may be more or less clinically relevant with time
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17
Q

What is classified as Multiple sclerosis?

A

White Matter Lesions

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18
Q

Why do we not observe grey matter lesions?

A

Contrast between demyelinate cortex and normal cortex is low

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19
Q

What is the pathology of multiple sclerosis (simplified)?

A
  1. Inflammation
  2. Demyelination
  3. Axonal transection
  4. Neuronal loss
  5. Gliosis
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20
Q

What is the role of myelin?

A

It doesn’t just enhance neuronal signal transmission but provides support to underlying axons

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21
Q

Where is neuronal loss observed?

A

Grey matter

22
Q

What is Gliosis?

A

Scarring of the tissue where there has been inflammation which limits capacity for repair

23
Q

What do lesions go through?

A

Dynamic processes

24
Q

When does the lesion load increase?

A

As people transit from CIS to RRMS

25
Q

When does the lesion load decrease in their rate of formation?

A

As they enter the progressive phase

26
Q

When does the brain atrophy accelerate?

A

As people enter the progressive phase

27
Q

Where are the more neurodegenerative features observed?

A

Grey matter

28
Q

How do you look at white matter lesions?

A

T2 sequence of MRI

29
Q

What is the clinico-radiological paradox?

A

Looking at correlation between number of T2 lesions and disability on the EDDS scale

30
Q

What is the radiological paradox?

A

A lot of lesions are observed on the scan but in terms of explaining what is going on is a poor measure

31
Q

What is the genetic aetiology of multiple sclerosis?

A
  1. About 25% concordance between identical twins
  2. About 3% concordance between non-identical twins
  3. HLA DRB1*1501
  4. IL7 and IL2
32
Q

Where is multiple sclerosis more common in?

A

Northern-hemisphere countries

33
Q

What is the environmental aetiology of multiple sclerosis?

A
  1. About 3% concordance between non-identical twins
  2. About 1.5% or less between non-twin siblings
  3. Sun exposure
  4. Vitamin D
  5. EBV
  6. Smoking
34
Q

What is good at picking up white matter lesions?

A

PD

35
Q

When will you see enhancing lesions?

A

When the BBB is disrupted and it will leak out

36
Q

What will not all MS lesions do?

A

Enhance

37
Q

Where does MS lesions tend to occur?

A

Around veins

Used to identify relatively characteristic features of WML

38
Q

What is the evidence when you look at lesions?

A

There is both demyelination and remyelination potentially in the same lesions over time

39
Q

What are the measures of detecting multiple sclerosis pathology (proton MRI)

A
  1. Magnetisation transfer
  2. Quantitative magnetisation transfer
  3. Myelin water fraction
  4. Diffusion Tensor Imaging
  5. Proton spectroscopy
40
Q

What is the pathology of 1. Magnetisation transfer

  1. Quantitative magnetisation transfer
  2. Myelin water fraction and NAWM?
A
  1. Pathology: Demyelination and axonal loss

2. NAWM: Reduction in MTR

41
Q

What is the pathology and NAWM of Diffusion Tensor Imaging?

A
  1. Pathology: Reductions in tissue integrity

2. NAWM: Decreased FA and Increased MD

42
Q

What is the pathology and NAWM of Proton spectroscopy?

A
  1. Pathology: Neuroaxonal damage (N acetyl aspartate)
  2. Astroglial pathology (myo-inositol)
  3. NAWM: Decreased NAA and increased mins
43
Q

What is the problem of non-proton MRI: Sodium (23NA)?

A

Less quality

44
Q

What are non-proton MRI: Sodium (23Na) compared to proton MRI?

A
  1. 22,000 times less abundant
  2. Different resonance frequency
  3. Much faster T2 relaxation
45
Q

What does a non-proton MRI: Sodium (23Na) require?

A
  1. Sodium coil
  2. Ultra short echo time sequence
  3. Optimised signal to noise
  4. Large voxels 4mm x 4mm x 4mm
  5. Scan time 23 minutes
46
Q

Where do the lesions in MS occur?

A

Outer surface of the brain

47
Q

What is cortical MTR?

A
  • Gradient of demyelination in the cortex using MTR
  • Lesions in the outer cortex
  • Measure the MTR in outer cortex
  • Shows more abnormalities in the outer cortex than inner cortex
  • Tissue abnormalities within the cortex is not even pool of abnormalities
48
Q

What is the difficulty with PET imaging?

A
  1. PET is very specific
  2. Traces very specific for cell lines e.g. astrocytic activation [myelin]
  3. Cannot keep injecting people with radiotracers
49
Q

What happens during MRI:?

A

Exciting protons

50
Q

What is more prone to atrophy than the brain?

A

Spinal cord

  • More vulnerable
  • Aggregating damage through tract degeneration
51
Q

What are the agents for MS progressive treatment trials?

A
  1. Simvastatin
  2. Ocrelizumab
  3. Siponimod
  4. Lipoic acid

C2 Modules CLINICAL (26 decks)

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