Lecture 5: MS

Question 1

Demyelination

Answer 1

disruption of myelin that coats neurons; makes the AP transmit slower

Question 2

Multiple sclerosis definition

Answer 2

an idiopathic inflammatory demyelinating dz of CNS ; caused by an autoimmune attack on oligodendrocytes

Question 3

Hallmark of MS

Answer 3

multiple scarred foci (plaques) with in the white matter of CNS and perivenular inflammation
-lesions primarily in white matter

Question 4

MS Pathophysiology:

Answer 4

under inflammatory cndtns T cells, B cells, macrophages, granulocytes cross BBB and enter CNS; once inside target self antigens on oligodendrocytes, decreasing myelin production

Question 5

Demographics of MS

Answer 5

• age preference: 15-55
• gender preference: females = 2:1
• Genetics
• Environment: born in northern states: 3x higher likelihood

Question 6

Sx’s of MS: Episodic relapses

Answer 6

• occur during different periods, but are short lived
• progress over hrs to days
• improve over days to weeks

Question 7

Chronic Sx’s of MS

Answer 7

heat sensitivity; bowel/bladder/sexual dysfxn; fatigue; mood disorders; cognitive dysfxn; gait impairment

Question 8

Most common Sx’s of MS

Answer 8

Limb sensory loss
Visual Loss: optic neuritis
Other: subacute weakness, diplopia, gait disturbance; balance probs; acute weakness

Question 9

Transverse myelitis

Answer 9

• sensory loss in one or both limbs
• L’hermitte’s phenomenon: when flex neck have sharp shooting tingling down length of spinal cord
• MS hug: feeling of tightness around chest

Question 10

Optic neuritis

Answer 10

• eye pain; decrease acuity

- optic disc edema

Question 11

Dx of MS: 2 things must have

Answer 11

1) dissemination in space

2) dissemination in time

Question 12

MS MRI

Answer 12

• diagnostic test of choice

- T2/Flair: lesions are hyper intense; found periventricularly, juxtacortical, infratentorial or spinal cord

Question 13

Dissemination in time

Answer 13

at least 2 lesions in locations typical for MS

Question 14

Dissemination in space

Answer 14

either clinically or on
MRI: T2/Flair: hyperintense lesions with simultaneous enhancing lesions or see hyper intense lesions or enhancing lesions on F/U

Question 15

Other diagnostic tools

Answer 15

• LP

- Evoked Potentials

Question 16

MS on LP

Answer 16

• see oligoclonal bands in CSF: represents increased synthesis of ABs with limited # of responsible antigens in CSF
• also see IgG in CSF

Question 17

MS Evoked Potentials

Answer 17

visual stimulation are presented and electrical impulse over primary visual cortex are recorded
-VEp will show increased latency suggesting signal thru optic nerve is slowed = optic neuritis

Question 18

Types of MS

Answer 18

1) Benign
2) Relapsing-Remitting
3) Primary progressive
4) Secondary progressive
5) Progressive Relapsing

Question 19

Relapsing-Remitting MS

Answer 19

• multiple episodes of transient neuro dysfxn which may or may not completely resolve
• But NO progressions btwn attacks = whatever disability had prior to attacks remains the same

Question 20

Primary Progressive

Answer 20

dz progresses relentlessly from onset

steady increase in disability w/out attacks

Question 21

Secondary Progressive

Answer 21

pts with relapsing remitting start to have progression btwn attacks; usually occurs after 17 yrs

Question 22

Progressive Relapsing

Answer 22

usually have relentless progression from onset but may have rare clinical relapses

Question 23

Clinically Isolate MS

Answer 23

First attack of MS

-2 common clinically isolated syndromes: optic neuritis and transverse myelitis

Question 24

Acute Relapse Tx of MS

Answer 24

IV methylprednisone

Plasma Exchange

Question 25

Dz Modifying Tx;s

Answer 25

• Interferon Beta 1a: avonex, rabif
• Interferon Beta 1b: Betaseron, extavia
• Copaxone
• *all have side effects

Question 26

Second line Agents

Answer 26

Mitoxantone

Natalizumab

Question 27

Oral Agents

Answer 27

Flingolimod
teriflunomide
dimethyl fumurate