Clinical Lecture: Multiple Sclerosis Flashcards
What is Optic Neuritis?
This is inflammation of teh optic nerve. It can cause pain and complete blindness. It is frequently not visible. 95% return to visual acuity within 12 months. A high does of steroids can be used to speed up the rate of recovery but has no effect on final acuity. 50% go onto develop MS within 10 years.
What is Transverse Myelitis?
Inflammation inside they cord. It is usually mild with a goof prognosis. It is often purely sensory. 50% go onto develop MS. Myelitis s commonly has a viral cause - the most common being Shingles or HZV. In others it is the first presentation of MS.
What is the requirement for diagnose of MS?
It is a clinical diagnosis: Requires you to have at least 2 attacks of inflammation in the CSF in different places which are disseminated in time and place e.g. Transverse Myelitis and Optic Neuritis.
True Or False: Recurrent Myelitis is sufficient for a diagnosis of MS?
False, the inflammation must occur in different places in the CNS to be sufficient for an MS diagnosis.
What is the epidemiology of MS?
- It is the most common cause of neurological disability in young adults in the IK
- Men: Women affected 1:2 like most autoimmune disease
- Age of onset is around 30-40 years
- Higher risk in Europeans - seen further away from the Equator
What is Multiple Sclerosis?
MS is an autoimmune condition of the CNS. It is an inflammatory reaction in the CNS leading to demyelination and slowing of conduction. There is loss of axons. The cause of autoimmune conditions is an issue with T lymphocytes not becoming tolerated to CNS self cells.
What type of treatments do we use in MS?
Immunosuppressants - Steroids and cytotoxic drugs tend not to work as well.
An example includes Furmarate.
How are TSYABRI’s used in the treatment of MS?
These are the first monoclonal antibodies approved for the treatment of MS. They inhibit adhesion molecules on the surface of immune cells. It stops the antibodies migrating into the CSF where they can cause inflammation and damage nerve fibres.
After the trial had finished patients were found to have Progressive Multifocal Leukoencephalopathy (PML) an AIDs defining illness. It is normally fatal. In these patients they had no immunity as the lymphocytes could not get into the brain.
We still use this drug but we need to screen for JC virus and PML.
Why do we use more aggressive treatment in MS?
We on the moment err on the side of aggressive treatment to delay or prevent the progressive phase. There is no effective treatment for progressive multiple sclerosis - even in primary progressive. Instead we use symptomatic treatment such as mapped, pain, tremor, Gentiosphincteral problems and spasticity. There is no way of telling benign patients at the start of the disease. We have to treat them as though they may develop onto this.
