Module 7: Multiple Sclerosis

Question 0

Environmental risk factors for multiple sclerosis?

Answer 0

#Vitamin D deficiency
#EBV
#Cigarette smoking

Question 1

Neuromyelitis optica – antigen? Symptoms?

Answer 1

“Bad MS”

Aquaporin 4 on astrocyte

Bilateral optic neuritis and visual loss

Question 2

Location of lesions in multiple sclerosis? Dawsons fingers?

Answer 2

Periventricular and subcortical regions

lesions travel along veins

Question 3

Classifications of multiple sclerosis?

Answer 3

#Relapsing and remitting
#Secondary progressive – fever overt relapses with time but slowly gets worse
#Primary progressive – no acute episodes
#Progressive relapsing – continues to get worse with episodes

Question 4

Why do new MS lesions appear on imaging?

Answer 4

Breakdown of blood brain barrier causes contrast enhancing lesion

Question 5

Findings in optic neuritis?

Answer 5

Pain and loss of visual acuity

Question 6

CSF findings in MS?

Another diagnostic test?

Answer 6

#Oligoclonal bands in CSF (that are not present in serum)
# increased IgG index and positive OCB 

Visually evoked potentials

Question 7

Treatment of relapses of MS?

If severe?

Answer 7

#High-dose IV steroids (if cannot be used, oral prednisone or ACTH)
#IVIG

if severe, plasma exchange

Question 8

First-line long-term treatment agents for multiple sclerosis?

Answer 8

#Interferons for relaxing/remitting (nothing approved for progressive)
#Glatiramer Acetate
#Monoclonal antibodies