CNS CLASS 10 - MS Flashcards
Multiple sclerosis is the one of the most common non-traumatic _______ _______ affecting young and middle-aged adults.
neurological conditions
T/F Canada has one of the LOWEST rates of multiple sclerosis (MS) in the world, with an estimated over 100K Canadians living with the disease.
FALSE HIGHEST
T/F As of 2013, Canada ranked fifth globally for number of cases.
TRUE
On average, _____ Canadians are diagnosed with MS everyday. Most people are diagnosed with MS between the ages of 20 and 49. In Canada, ___ is the average age of MS diagnosis. ___ % of people in Canada living with MS are female. Females are ___ times more likely to be diagnosed with MS than males.
12
43
75
3
T/F Overall incidence appears to be on the increase, although it is difficult to distinguish to what extent this finding reflects improvements in diagnostic technology. It is also presumed that many mild cases are never diagnosed.
TRUE
T/F One of the most compelling features of multiple sclerosis for health care practitioners is that no two cases are exactly alike.
TRUE
Discrete areas of damage develop in the ____, ____ ____ and _____ ______?
brain, spinal cord, and optic nerves.
They are random and unpredictable, both in location and in number. The symptoms each person exhibits are determined by the particular pathways disrupted in their brain. The body functions most commonly affected are (name 7)
vision, coordination, speech, strength, sensation, bladder control, and sexual function.
MS is not a terminal disease?
TRUE
T/F Conditions secondary to MS, like pneumonia, may cause death in severely affected individuals, but most live normal lifespans.
TRUE
T/F There is no cure, however, and MS is a disease which can greatly affect quality of life - the unemployment rate for people living with MS is a 60-80%.
TRUE
There appear to be several benefits that massage therapy can offer MS patients. The biggest contribution is in easing secondary effects of the disease in the body’s ____ ____. These ____ ____ changes, which impair mobility and function, can greatly reduce the quality of life of people with multiple sclerosis.
soft tissues (X2)
a proteolipid sheath which covers most of the axons which conduct nerve signals.
Myelin
In the central nervous system, myelin is made by ______ , whose myelin bundles are actually wrapped layers of cell membrane. Each ______ provides myelin to small regions of densely packed axons. Any given axon will have myelin bundles along its length supplied from a number of ______
oligodendrocytes (X3)
The myelin insulates the cell membranes of neighbour neurons to avoid mixing or confusing of ______ and improves the ability of the axon to carry ____ ____ , speeding up the ____ of impulses.
impulses
action potentials
conduction
Any process which results in myelin sheaths being lost or destroyed.
Demyelination
T/F MS is the most common demyelinating condition in the PNS.
FALSE IT’S IN THE CNS
the characteristic lesion of MS.
Plaque
When the disease is active, ____ destruction occurs in localized patches. The stripped sections appear as greyish-coloured spots in the white matter. ____ average 1-15 mm in size.
myelin
Plaques
An active plaque site is an ________________ _________________lesion with large numbers of infiltrating lymphocytes and macrophages
Edematous Inflammatory
These immune cells consume _____ and attack ______, rapidly killing them off. Chunks of _____ are transferred from the neurons to the large ______.
myelin
oligodendrocytes
myelin
macrophages
______, the major supporting and structural cells in CNS tissue, migrate to the site.
Astrocytes
______ role is to react to the injury by congregating together and synthesizing fibre processes to form a living scar_______
Astrocytes
GLIOSIS
These lesions are called plaques because the _____ fibres make them harder than the surrounding tissue. Old inactive _____ are fields of _____ demyelinated axons with gliosis filling the intervening spaces where the_____ bundles used to be.
glial
plaques
permanently
myelin
describes a period of active demyelination, often referred to as a relapse or ‘flare-up’.
Exacerbation and Remission
T/F The rate at which people with MS have exacerbations is very variable, but the average is every seven months.
FALSE IT’S EVERY EIGHTEEN MONTHS
_______ is the period between exacerbations and can signify complete disappearance of the disease.
Remission
When an ______ occurs, the most common presentation is sudden onset of neurological symptoms, usually over a period of several hours to a few days.
exacerbation
The symptoms last for 6-8 weeks, then gradually resolve over 2-3 months. Depending on the stage and severity of the disease, the remission may return the person to normal or near normal function, or there may be considerable new disability. Name these two periods of active demyelination?
Exacerbation and Remission
T/F MS is an inflammatory disease resulting from an autoimmune reaction.
TRUE
Immune system cells, responding to an unknown stimulus, accumulate in venules in the___ and exit the bloodstream into the ____. Once there, they attack____ , and in their wake leave a collection of ____ . The location of these plaques, while quite random, tends to be denser around blood_____ and the _____.
CNS
tissue
myelin
plaques
vessels
ventricles
It is believed that a component of myelin called myelin _____ _____ is the target of the attack. The theory is that the person’s ____ ____ ____ was breached, allowing immune cells which are normally excluded to enter the ____ tissue environment. These cells release chemicals that cause inflammation and damage to the _____, the _____ and the _____. The cells appear to make a determination that myelin is a potentially _____ substance (in other words they perceive it as an antigen). _____ against it are prepared for use at a future time.
basic protein
blood brain barrier
CNS
myelin, neurons and oligodendrocytes
threatening
Antibodies
When myelin is stripped away, the uncovered axon sections do not have sufficient ionic channels for _____ and the axon transmits poorly, if at all. _____ which does occur requires high energy expenditure by the neuron. Firing may be erratic or inappropriate due to loss of the insulation which prevents spontaneous or spill-over signals. A broader dysfunctional effect is produced because transmission in other parts of the____ is dependent on timely, stimulus-appropriate signals along the affected pathways.
depolarization
Conduction
CNS
When the disease goes into an _____ phase, attacks ensue at one or more locations. The _____ may be new or they may be _____ at old sites._____ takes 1-2 weeks. One type of microglia (the resident _____ of the CNS) promotes inflammation and _____ damage.
exacerbation
plaques
reactivations
Demyelination
macrophages
oligodendrocyte
The phagocytosis of myelin debris by a second subgroup of microglia plays an important role in the initiation of ______ Oligodendrocytes reappear at the site and begin remyelinating the axons. A small number may be survivors of the attack, but most have been formed by replication of nearby healthy cells. For most individuals in the early stages of the disease, the______ do excellent damage repair, restoring normal or near normal function. This is where the _______/_______ cycle comes from.
remyelination
oligodendrocytes
exacerbation/remission
After repeated attacks, especially at the same site, the_____ become less _____ . Their failure to maintain the cycle of repair is probably due to the cumulative effects of multiple _____. Eventually the oligodendrocytes disappear or become completely_____. As the plaque progresses from acute active to chronic inactive, its edema resolves, inflammation decreases, and microglia gradually disappear. Astrocytes produce _____ fibers, and ultimately a glial scar fills the demyelinated plaque (____ ____ ____). These characteristics prompted Charcot to name the disease “sclerose en plaque” and are also responsible for the distinctly demarcated, firm, retracted, and brownish discoloration of the long-standing chronic MS plaques on gross pathology images.
oligodendrocytes
effective
insults
dysfunctional
glial
astrocytic fibrillary gliosis
T/F In time there is often joining up of nearby plaques, creating larger fields of impulse conduction disruption.
TRUE
T/F Symptoms are most severe during an exacerbation and subside either partially or completely once it is over
TRUE
The axons are eventually damaged, and axonal damage/loss and the development of_____ inactive_____ are the major determinants of profound neurological deficit in MS sufferers.
permanent
plaques
T/F Exacerbations cannot occur at any time, but are more likely if the person’s overall health is impaired.
FALSE THEY CAN HAPPEN AT ANY TIME!
T/F Chronic symptoms can also worsen for short periods, for example if the person is ill.
TRUE
T/F Not everyone with MS has a well-defined course of exacerbations and remissions.
TRUE
T/F Some have an extreme form of the disease with little or no remission time, while others have only one or two exacerbations in their lifetimes.
TRUE
T/F Some people do not have exacerbations, but instead display a low-grade chronic type of disease.
TRUE
T/F As the disease progresses, in most individuals there is less distinction between states of flare-up and remission.
TRUE
Each person experiences a unique chronology of these events. As the disease progresses, there can be a variety of acute, subacute, and inactive _____ scattered throughout ____. The resulting disability pictures range from clinically insignificant to totally physically disabled.
lesions
CNS
T/F The cause of MS is not known
TRUE
Scientists believe ____ is triggered by a combination of factors: immunological, environmental, infectious, and genetic factors
MS
One gene that plays a key role in MS that has been best studied is the ___ ____ ___
HLA- DRB1 gene
HLA- DRB1 gene belongs to the ____ ____ _____ (aka)
human leukocyte antigen (HLA) complex family
The ____ complex allows the immune system to discriminate
between the body’s own proteins and proteins made by foreign
invaders (like viruses or bacteria). ____ genes come in different
variations, which makes the immune system apt to respond to foreign invaders.
HLA (X2)
Changes in many HLA genes have been linked to increased ___ risk, with the HLA-DRB1 1501 variation the strongest associated genetic change related to ___ development.
MS (X2)
_____ and _____ (lymphocytes) are two important immune cells that play a role in the abnormal immune response caused by MS.
T-cells and B-cells
T cells and B cells become activated in the ____ system and in MS, enter the CNS through ____ vessels. Once in the CNS, these cells release chemicals that cause inflammation and damage. This results in damage to _____ , _____ and _____. T cells call on other immune system cells to participate in the immune _____.
lymph
blood
myelin, nerve fibres and oligodendrocytes
attack
T _____ cells, a type of T cell, dampen or turn off inflammation. In MS, T _____ cells do not function correctly and do not effectively turn off inflammation.
regulatory (X2)
______ or “killer” T cells directly attack and destroy cells bearing certain characteristics.
Cytotoxic
