Lecture 64: Multiple Sclerosis

Question 1

Typical MS lesion sites/symptoms (4)

Answer 1

Monocular vision loss, brainstem syndromes (cranial nerve deficits), spinal cord = motor/sensory impairments, imbalance

Question 2

Early features

Answer 2

Motor weakness, paresthesias, impaired vision, double vision, intention tremor, ataxia

Question 3

T/F: Diagnosis of MS is certain initially

Answer 3

False! One lesion location is hard to diagnose

Question 4

How do you recognize MS early?

Answer 4

MRI!

Question 5

Original triad for MS presentation and where they localize. How do we feel about this now?

Answer 5

Intention tremor, nystagmus, scanning speech (WM pathways to and from cerebellum); we now try to treat LONG BEFORE its gotten this far

Question 6

What is the most common place for MS lesion? Name of disease and presentation.

Answer 6

Optic nerve; neuritis; painful gradual (days) loss of vision in ONE eye often with scotoma of central vision

Question 7

How often do you see optic edema? How many patients w/ optic neuritis get better completely? How many will end up with MS?

Answer 7

50%; 33%; 50%

Question 8

Four CRITICAL clinical patterns of MS. Does a patient always have just one?

Answer 8

Relapsing remitting; secondary progressive; primary progressive; progressive relapsing; NO–secondary progressive FOLLOWS relapsing-remitting

Question 9

Relapses get more/less frequent over time

Answer 9

Less frequent

Question 10

Describe secondary progressive disease

Answer 10

Starts w/ relapses, but then continues to progress (more disability) over time w/ or w/out relapses

Question 11

Do lesions always coordinate with symptomology?

Answer 11

Nope! Can have many new lesions w/out new symptoms

Question 12

% patients who begin with RRMS, % who will go into secondary-progressive

Answer 12

85%; 50% (NATURAL HISTORY, NOT W/ TREATMENT)

Question 13

Epidemiology of MS (age, gender, race, location)

Answer 13

20-40; 2-3 x women; N European; more w/ northern exposure

Question 14

Genes of MS

Answer 14

Higher risk in first degree relatives

Question 15

Criteria in MS (name) and principle

Answer 15

McDonald Critera; look for evidence of dissemination in space and time

Question 16

When you give dye…what lights up?

Answer 16

Areas of the nervous system that are actively inflamed, light up

Question 17

Classical MS lesions

Answer 17

Multiple, round, peri-ventricular WM

Question 18

Relationship b/t MS and lesions

Answer 18

MRI lesions predict development of MS after first attack

Question 19

What causes MS on a cellular level?

Answer 19

Inflammatory attack of oligodendrocytes by self-reactive T1 cells that cross compromised BB barrier

Question 20

Misguided T cells mistake…

Answer 20

Myelin for an antigen

Question 21

CSF in MS

Answer 21

Increased IgG synthesis rate and IgG oligoclonal bands (90% have them but we don’t know what they target)

Question 22

Under the microscope…

Answer 22

Inflammatory infiltrates in MS lesions

Question 23

Treating exacerbation

Answer 23

High dose IV steroids

Question 24

Goals of treatment (4)

Answer 24

Prevent relapse, prevent disability, clinical stability, decrease new lesions

Question 25

Where do lesions always call symptoms?

Answer 25

Spinal cord, optic nerve (shallow end)

Question 26

Where do lesions rarely cause symptoms?

Answer 26

Juxtacortical, periventricular (deep end)

Question 27

Where do lesions sometimes cause symptoms?

Answer 27

Brainstem, cerebellum

Question 28

What happens over time with MS?

Answer 28

The reserve is decreased (loss of neurons), eventually the many lesions come to light