Lecture 6: MS & Epilepsy Flashcards
Which environmental risk factors for MS can you name?
- Low vitamin D
- Epstein-Bar Virus
- Smoking
What are some symptoms that are most common in the early stages of MS?
Double/blurred vision, numbness, weakness in extremities, instability in walking, tremors, problems with bladder control, cognitive and mood problems
What are 2 phases in the course of MS?
- Relapsing-remitting phase: early stage of the disease > autoreactive immun cells traffic into the CNS > results in focal inflammation and demyelination. Relapses are then followed by periods of remission as inflammation resolves and remyelination occurs
- Secondary progressive phase: over time chronic inflammation with scar formation (=sclerosis), accumulation of axonal damage, brain atrophy, and inhibition of remyelination contribute to progressive worsening disability
Name 2 ‘statements’ about the diagnosis of MS
- Dissemination in space: 1 or 2 lesions typical of MS present in 2 or more sites within the CNS
- Dissemination in time: requires that 2 attacks seperated by more than 30 days have occured in different parts of the CNS
Why are ‘evoked potential tests’ used in patients with MS?
To examen how long it takes for the brain to respond to visual stimulation, since MS often starts with visual problems due to damage to the optic nerves (looking at a flashing chessboard pattern with electrodes)
Which neuropsychiatric problems are very common in MS?
- Depression
- Bipolar disorder
- Euphoria
- Psychosis
- Personality change
- Anxiety disorder
Which personality changes when…
- Damage in orbitofrontal-subcortical circuits
- Damage in anterior cingulate-subcortical circuits
- Profane, disinhibited and socially inappropriate behaviors
- Apathy & indifference
What are the 2 most commonly affected cognitive domains in MS?
(Visual) memory and information processing speed
Which type of atrophy has been associated with cognitive impairments in MS?
Especially thalamic atrophy
Explain the following tests from the Brief Neuropsychological Battery (BRNB)
- SDMT
- SRT
- 10/36 SPART
- PASAT
- Word list generation
- Symbol Digit Modalities Test = most popular test in MS. It examines information processing speed and working memory (substitute meaningless symbols by corresponding numbers)
- Selective Reminding Test = to measure verbal learning and memory recall. Similar to the 15WT, but now there are 12 words and noly the words that are missed are given by the test instructor
- 10/36 Spatial Recall Test = to assess visuospatial learning and late recall (a board with dots that the subject has to reproduce)
- Paced Auditary Serial Addition Test = 2nd most popular test in MS, to assess processing speed and working memory (patients need to add pairs of digits presented at rates of speed, the 2 second condition is hard for MS patients)
- Word list generation = a semantic fluency test
What 3 types of treatments can be offered to patients with MS?
- Disease modifying therapies: it might help preserve intact cognitive functioning and delay the development of cognitive impairment (however, weak positive effects on cognition)
- Acetylcholinesterase inhibitors = promising, but studies with small sample
- Behavioral interventions = cognitive/strategy training (limited data on effectiveness, but targeted interventions to improve acquisition in verbal memory and learning show promise
What is a simple partial seizure? Name some symptoms.
Without loss of consciousness (these symptoms may not be seen from the outside)
- May alter emotions
- Change how things look, smell, feel, taste, sound
- Involuntary jerking of a body part
- Sensory symptoms, like tingling, dizziness, flashing lights
What is a complex partial seizure? Name some symptoms.
With impaired awareness
- Change/loss of consciousness
- Stare into space and not respond normally to environment
- Perform repetitive movements
Explain the following seizures.
- Absence seizure
- Tonic seizure
- Atonic seizure
- Clonic seizure
- Myoclonic seizure
- Tonic-clonic seizure
- Absence seizure (petite mall seizure): often occur in children, staring into space, subtle body movements, may cause brief loss of consciousness
- Tonic seizure: stiffening of muscles, may cause fall
- Atonic seizure (drop seizure): loss of muscle control, may cause sudden collapse or fall
- Clonic seizure: repeated, rhythmic jerking muscle movements
- Myoclonic seizure: sudden brief jerks or twitches of arms and legs
- Tonic-clonic seizure (grand mall seizure / convulsive seizure): most dramatic type, abrupt loss of consciousness, body stiffening and shaking, sometimes loss of bladder control or tongue bite
What is meant by ‘aura’?
Some people use this term to describe the warning they feel before they have a tonic-clonic seizure. It is in fact a focal aware seizure
