Intro to MS

Question 1

What type of neurology problem is likely with a 
1. Acute
2. Subacute
3. Progressive
symptom evolution

Answer 1

1. Vascular
2. Inflammation/infection
3. Degeneration or tumor

Question 2

4 classic MS presenting attacks

Answer 2

Optic neuritis
Transverse myelitis
Brainstem inflammation (INO, ataxia)
Multifocal (multiple areas at the same time)

Question 3

Brainstem lesions often cause what 2 symptoms

Answer 3

Ataxia
Double vision (INO)

Question 4

Transverse myelitis

Answer 4

Lesion that grows across the spinal cord at a single level

Because of the somatotopic organization of the spinal cord it looks like it is going up the limbs

Question 5

MS mechanism of damage

Answer 5

Lymphocyte activation in the periphery
Crosses the BBB
Recruitment of macrophages and other immune cells
Inflammation and demyelination
NO release (as part of the toxic process - also causes conduction block)
Axonal injury (from the acid thats floating around with inflammation

Question 6

Why do the areas of damage show up as white on MRI?

Answer 6

Because its showing the accumulation of water

Question 7

Cellular mechanisms of recovery

Answer 7

Stop active inflammation
Remove NO and cellular debris
Insert Na channels (to compensate for the loss of transformation)
Use alternate pathways (compensation)
Remyelination

Question 8

What is the problem with axonal injury?

Answer 8

Leads to incomplete recovery and permanent disability

Damage can accumulate

Question 9

Basis of MS diagnosis

Answer 9

Attacks of CNS inflammation that are disseminated in space and time

Question 10

3 supportive tests to diagnose MS

Answer 10

MRI
Visual evoked potential for slowed waveform (document a previous optic neuritis)
Lumbar puncture for oligoclonal banding

Question 11

Why use a FLAIR MRI?

Answer 11

Causes normal water to look dark, but abnormal water to look bright

Question 12

Causes of MS

Answer 12

Environment and genes
Link to low vitamin D
EBV link

Question 13

4 types of meds to treat MS

Answer 13

Injectables: glatiramer acetate and interferons (rarely used anymore)
Orals: fingolimod, dimethyl fumarate
Monoclonal antibodies: nataluzumab, rituximad
Autologous hematopoietic stem cell transplant (bone marrow transplant)

Question 14

Therapies for MS can use 4 different mechanisms of action

Answer 14

Interrupt lymphocyte communication
Tolerance
Block lymphocyte trafficking
Destroy lymphocytes

Question 15

9 permanent disabilities people can be left with

Answer 15

Fatigue
Depression
Cognition
Neuropathic pain
Spasticity
Neurogenic bladder
Sexual dysfunction
Swallowing
Immobility