Clinical Perspective - Multiple Sclerosis & Demyelination Disorders

Question 1

What are the most common symptoms seen in a patient who presents with multiple sclerosis?

Answer 1

Numbness/tingling, fatigue, pain, difficulty walking

Question 2

Multiple sclerosis onset is most often between what ages?

Answer 2

Ages 15-55 and more common in women than men

Question 3

What is a neuro-immune disease?

Answer 3

A disease that is triggered and/or maintained by gross or molecular inflammation

Question 4

CN II is especially at risk for multiple sclerosis-associated demyelination. Why is this?

Answer 4

CN II is the only cranial nerve made of CNS myelin. Vision issues are generally an early indication of MS

Question 5

Activation of what T cell cellular response is responsible for the development of Multiple Sclerosis?

Answer 5

Th1 & Th17

Question 6

How do the symptoms of multiple sclerosis present clinically?

Answer 6

Symptoms develop over days and resolve within weeks. Relapse of MS requires the onset of new symptoms and not the reemergence of existing symptoms

Question 7

Multiple sclerosis always presents with (upper/lower) motor neuron deficits.

Answer 7

Upper motor neurons - MS is a CNS disease

Question 8

This disease is similar to multiple sclerosis, but involves astrocytes and creates lesions primarily in the spinal cord and optic nerves.

Answer 8

Neuromyelitis Optica Spectrum Disorder

Question 9

Myasthenia gravis and Guillan-Bare are neuro-immune diseases of the (CNS/PNS)?

Answer 9

PNS

Question 10

What mechanisms are responsible for demyelination associated with multiple sclerosis?

Answer 10

Brain inflammation, alterations of ion balances and charges

Question 11

What pathophysiologic changes characterize multiple sclerosis?

Answer 11

Inflammation, demyelination, axonal damage, gliosis

Question 12

What imaging modality is required to positively diagnose multiple sclerosis?

Answer 12

MRI - MS cannot be diagnosed without a positive MRI that shows the presence of plaques

Question 13

True/False. A lumbar puncture and MRI are required to diagnose multiple sclerosis.

Answer 13

False. A positive MRI is required for diagnosis, but an LP is not. An LP is only positive ~50% of the time

Question 14

True/False. Multiple sclerosis begins with the development of antibodies within the CNS.

Answer 14

False. MS begins with antigen presentation within lymph nodes and the activation of CD4+ T cells. Activated T cells cross the BBB to enter the CNS and cause inflammation and dysregulation

Question 15

What is the MOA of injectable drugs for the treatment of multiple sclerosis?

Answer 15

Prevent lymphocyte activation (Avonex, Betaseron, Copaxone)

Question 16

What is the goal of multiple sclerosis treatment?

Answer 16

Immune suppression

Question 17

What is the MOA of oral drugs for the treatment of multiple sclerosis?

Answer 17

Prevent the egress of activated lymphocytes from lymphatic tissues - decreases T cell population

Question 18

What is the most common type of multiple sclerosis?

Answer 18

Relapsing-Remitting MS - unpredictable attacks followed by periods of remission

Question 19

Multiple sclerosis is associated with a genetic mutation of what allele?

Answer 19

HLA-DRB1