Demyelinating Disorders

Question 1

MS subtypes

Answer 1

• Relapsing-Remitting (RRMS)
• Primary Progressive (PPMS)
• Secondary Progressive (SPMS)

Question 2

– 85% present in this manner. Multiple attacks over time.

– Evolving/worse symptoms&raquo_space; remission

Answer 2

Relapsing-Remitting (RRMS)

Question 3

– 15% present this way. More common in middle age.
– Continuous progression from outset, variable rate
– Non inflammatory

Answer 3

• Primary Progressive (PPMS)

Question 4

– Majority of RRMS converts to progressive disease

Answer 4

• Secondary Progressive (SPMS)

Question 5

MS - Epidemiology

Answer 5

• 3/4 Present between 15-45, 5%

Question 6

MS Causes - Genetic

Answer 6

Risk linked to HLA DR2; Link to IL-7 receptor, IL-2 receptor mutations
Increased risk in (FDRs), x 10-20 fold
Increased risk in monozygotic (30%) vs dizygotic (5%) twins
Abnormal brain MRI scans in about 10% of asymptomatic family members

Question 7

MS Causes - Environmental

Answer 7

• Cigarettes linked to risk of developing disease, worse progression
• Vitamin D deficiency is linked to risk of developing disease, worse progression, BUT
– Supplementation and raising of blood levels NOT yet shown to slow disease activity
• Obesity linked to risk of developing disease and likely to progression

Question 8

MS - CSF Analysis

Answer 8

• Protein usually less than 110 mg/dl
• WBC rarely more than 40/mm3, mostly lymphs
• Glucose always normal
• Immunoglobulins in CSF, abnormal in about 95%
**– Oligoclonal bands

Question 9

Natalizumab

Answer 9

Humanized monoclonal antibody
Prevents wbc from crossing bbb
68% reduction in relapse rate and eliminates new lesions
Risks: PML (dendrite virus),