L15 Multiple Sclerosis Flashcards

1
Q

What is Multiple Sclerosis

A

Auto-immune disorder

Immune Sytem attacks the myelinated axons in the CNS

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2
Q

What system does MS affect

A

Central Nervous System

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3
Q

When does the onset of MS begin

A

Ages of 20-50

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4
Q

Frequency of MS in society

A

Twice as common in women
1-1000 people in ireland diagnosed
2.8 globally affected

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5
Q

What does growing evidence show about the geography of MS

A

More frequent in areas further from equator
Studies linking the Vitamin D

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6
Q

3 Characteristics of MS

A

Destruction of Myelin Sheaths around neurons

Formation of lesions in CNS

Chronic Inflammation (activated microglia cells)

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7
Q

What do areas of myelin loss show in images

A

plaques/lesions

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8
Q

What is myelin

A

Insulating layer, or sheath that forms around nerves (brain and spinal cord)

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9
Q

Function of Myelin Sheath

A

Propogation of electrical impulses along axons is highly accelerated by myelin sheath

Produces saltating or jumping action potentials across internodes, from one node of ranvier to the next

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10
Q

Myelination in CNS and PNS

A

Oligodendrocytes (CNS)

Schwann Cells (PNS)

Both types of glia (non-neuronal cells in nervous system )

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11
Q

Glia Cells in the CNS (Brain, Spinal Cord)

A

Astrocytes: support immune function

Oligodendrocytes: insulation, myelination

Microglia: immune function, phagocytes

Ependymal Cells: create CSF

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12
Q

Glia Cells in PNS

A

Schwann Cells: insulation, myelination

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13
Q

Oligodendrocytes

A

Location: CNS
Function: Myelinating Axons
Disease Associated: MS

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14
Q

Schwann Cells

A

Location: PNS (myelinate the nerve cells that project to and from muscles, internal organs)

Function: responsible for myelinating a small portion of an axon

Disease Associated: Guillain- Barre syndrome

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15
Q

What is a multi-factorIal disease?

A

No single cause has been found, but a number of risk factors have been identified

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16
Q

Risk factors that may cause MS

A

Exposure to certain Viruses (Epstein-Barr = Glandular Fever)

Genetic Susceptibility

Environmental Factors: lack of sunlight, smoking, teenage obesity, pollutants, gut microbiota, stress and exercise

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17
Q

What causes demyelination resulting in MS

A

Risk factors together cause abnormal immune response against self antigen Myelin, leads to demyelination of axons

18
Q

Pathophysiology of MS

A

Activated T & B lymphocytes

Cross the Blood Brain Barrier

Infiltrate brain and spinal cord

Activate Microglia

Release Cytokines

Macrophages attack myelin and phagocytes large chunks of the myelin sheath

Loss of Myelin

Plaques of demyelination in white matter, demyelinating lesions in grey matter

Disappearance of oligodendrocytes and proliferation of astrocytes

Axonal loss and degeneration

Loss of signal conduction

19
Q

Symptoms of MS

A

Often unpredictable
Differ greatly between people
May be mild or severe, short term or long term

> > this dependent on the location of the affected nerve fibres

20
Q

Symptoms of Multiple Sclerosis

A

Vision Problems: such as optic neurotis (blurriness and pain in one eye) are often one of the first signs of MS

Changes in gait
Fatigue
Loss of Balance
Muscle Spasms
Muscle Weakness
Tingling pr numbness, especially in arms or legs

21
Q

Course of MS

A

Most people with MS have a relapsing- remitting disease course

  • experience periods of new symptoms or relapse that develop over days or weeks and usually improve partially or completely

these relapses are followed by quiet periods or remission that can last months to years

23
Q

Types of MS

A

Relapsing- Remitting MS (RRMS)
Secondary Progressive MS (SPMS)
Primary Progressive MS (PPMS)
Progression Relapsing MS (PRMS)

24
Q

Relapsing Remitting MS

A

Flare ups and periods of remission

25
Secondary Progressive MS
Starts like RRMS but there is stable progression of the disease and symptoms between relapses
26
Primary Progressive MS
Symptoms that slowly and gradually worsen without any periods of relapse or remission
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Progressive Relapsing MS
Steadily worsens from the onset of the first symptoms, regardless of relapses or periods of remission
28
What are complications of MS
If MS progresses, worsening symptoms may lead to complications such as : - Difficulty walking -Loss of bowel or bladder control - Memory problems - Speech Difficulties - Increase risk of life - threatening conditions
29
How is MS diagnosed
1) Detailed Neurological examination - shows whether nerve pathways are damaged 2) Lumbar Puncture- reveals if there has been a breakdown of antibodies and oligoclonal bands which are suggestive of MS 3) MRI scans of the brain and spinal cord- to look for characteristic lesions of MS 4) Evoked potential tests -
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What shows in MRI if MS is present
white spots correspond to demyelinating lesions
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Treatment of MS
No cure Treatment focuses on -speedy recovery from attacks reducing new clinical relapses slowing the progression of the disease managing MS symptoms
32
Treatment for an MS attack
Corticosteroids Oral Prednisone Intravenous Methlyprednisolone >>inhibit the synthesis of inflammatory proteins, through the suppression of the Plasma exchange >> the liquid portion of blood is removed and seperated from the blood cells. Mixed with protein solution and put back into body
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Treatment to modify disease progression
Injectable : - Interferon beta medications - Glatiramer -Monoclonal >>Lowere relapse rater >>slow the formation of new lesions >>potentially reduce risk of brain atrophy and disability accumation
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Interferon Beta Medication
Balances the expression of pro and anti- inflammatory agents in the brain, and reduces the number of inflammatory cells that cross the BBB Increase the production of nerve growth factors -Avonex -Betaseron -Rebif
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Glatiramer Acetate
Modifiy the immune processes that are believed to be responsible for the pathogenesis of MS Inhibit the secretion of proinflammatory cytokines Inducing the T-cells to cross the BBB and produce anti-inflammatory cytokines Examples - copaxine - glatopa
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Monoclonal Antibodies
Reduces the level of B cells which contribute to the development and progression of MS Binds to and blocks the action of CD-20, a molecule expressed on the surface of both healthy and leukimic B Lymphocytes Eg. - Kesimpta -Arzerra
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Oral Medications for MS Progression
Teriflunomide Fingolimid Dimethyl Fumarate >>reduces the relapse rate
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Teriflunomide
ORAL Reduces the proliferation of activated T and B lymphocytes eg. aubagio
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Fingolimid
Shifts macrophages to an anti-inflammatory phenotype. It modulated their proliferation Eg. gilenya
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Dimethyl Fumarate
Lower levels of B lymphocytes Blocks pro-inflammatory cytokine productiong. Tecfidera
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Cannabis
No cannagis based FDA approved medications for MS Clinical Trials have shown it improves pain and spasticity, bladder issues in people with MS
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