Inflammatory/Demyelinating Diseases Flashcards
There are two phenotypes of multiple sclerosis. What are they?
Relapsing-remitting (85%): periodic attacks that worsen with time
Progressive (15%): continuous progression from the onset
Relapsing-remitting MS can evolve into _____________. What is this called?
progressive; secondary progressive
Describe the rough demographics of MS.
More common in women
HIghest incidence in 18 - 45 yo
What histologic pattern is (oddly) seen in the meninges of those with MS?
A lymph-node-like structure with B cells
Describe the bizarre relationship between duration of MS, age, inflammation, and disability.
In those with MS, inflammation in the CNS usually goes down with age and duration of disease; however, people still tend to get worse (i.e., develop more CNS symptoms), despite lessening of inflammation!
Risk of MS is much lower in those who are _______ negative.
EBV
What is the monozygotic concordance rate of MS?
30% (dizygotic is only 5%)
The _______ genotype has been linked to MS, but the odds ratio is only 1.1.
HLA-DR2
What test is very sensitive to MS diagnosis?
MRI –can detect multiple lesions after even one attack; importantly, even one lesion after an MS-like attack is predictive of future attacks.
Early MS lesions usually produce _______ symptoms, while later MS lesions usually produce _________ symptoms.
focal; general
How do MS lesions appear on T1 and T2 MRIs?
T1: hypointense
T2: hyperbright
What percent of those with MS will go on to develop secondary progressive MS?
50%
Multiple sclerosis can lead to ___________ transection.
axonal (though axons are mostly spared)
What modifiable risk factors have been shown to increase risk of developing MS and of having a worse progression of MS?
Cigarettes
Obesity
EBV
Vitamin D deficiency
What brain structure often undergoes marked atrophy in those with MS?
The corpus callosum –a bundle of white matter, which may be attacked in MS
What are bad prognostic signs in someone with MS?
Gray matter atrophy
Spinal cord lesions
Cerebellar lesions
High disease burden on MRI
Explain the presentation and prevalence of benign and malignant MS.
Benign (10%): rare attacks, no disability
Malignant (5%): rapidly progressive, wheelchair in 5 years
How are acute MS attacks treated? What if that treatment fails?
Methylprednisone (solumedrol)
If that fails, perform plasmapharesis.
What new therapies are very promising for MS treatment?
Ocrelizumab
Natalizumab (integrin antagonist)
Daclizumab (IL-2 receptor antagonist)
Disease-modifying therapies are most effective in __________ patients.
younger
How many people have MS in the U.S.?
400,000 (10,000 new cases per year)
MS is a disease of the __________ nervous system.
central
Primary progressive MS most commonly appears in what age group?
Middle age
What destroys myelin in MS?
Lymphocytes, macrophages, and antibody
What time/space criteria need to be met to achieve a diagnosis of RRMS and PPMS?
RRMS: two separate lesions occurring for at least 24 hours 30 or more days apart
PPMS: continuous lesions for at least 12 months
After a CIS, what percent of people go on to have a second attack?
88%
