MS Flashcards
What are the white spots on brain MRI pictures called?
Periventricular lesions
Is MRI an indicator of neurological deficit in MS patients?
No, MRI is only a secondary indicator of disease progression because there is no specific correlation between lesion and neurological deficit
what is the incidence of multiple sclerosis?
1:500 to 1:1000 (2-3 patients diagnosed every day)
Describe what kind of factors contribute to risk of acquiring MS?
Caucasian, 25-38, more prevalent in females, genetic predisposition to develop MS if you have 1st relative with it
What is the ratio of susceptibility to MS in terms of gender, females to males?
3:1
Is MS hereditary?
No, but one can have a genetic predisposition to it
What does it mean when an individual has a first degree relative who has MS?
This individual has absolute risk of MS <5% which equates to 20-40% increased risk compared to the general population
presence of what allele increases the risk of MS?
HLA-DR2 allele
What are the 3 theories of MS?
- Infectious Theory
- Molecular Mimicry
- Autoimmune Disease
What is the pathological explanation for MS?
MS is a chronic neurological auto-immune disorder caused by pathological activation of inflammatory TH1 cells
How do TH1 cells enter the brain?
Once TH1 cells are docked/stuck to adhesion molecules, they are still releasing mediators of inflammation which activate proteases at surface level of blood-brain barrier. These proteases cause the blood-brain barrier to loosen up and allows Th1 cells to pass through into the central nervous system
what is the median time for someone with MS to require a cane/crutch upon 1st diagnosis?
15 years
what is the median time for someone with MS to require wheelchair confinement upon 1st diagnosis?
25 years
Does time after diagnosis and initiating treatment have an affect on the degree of disability of an individual over time?
Yes, the earlier the treatment, the better. Early intervention may have the greatest potential impact on both pathological and clinical course.
What are clinical diagnostic tools to help diagnose MS?
- Examination of cerebra-spinal Fluid
2. MRI
what is found in the CSF of MS patients?
oligoclonal IgG bands (in >95% patients with clinically definite MS). They tell us whether there are antibodies against oligodendrocytes
What are the types of MS?
- RRMS (Relapsing and Remitting)
- CIS (Clinically isolated syndrome)
- SPMS (secondary Progressive MS)
- PPMS (primary-progressive MS)
CIS - Clinically Isolated Syndrome
“benign MS” that always stays below baseline. May not need treatment because normal life is not affected
PPMS - Primary-Progressive MS
- This usually hits males and is the worst type of MS. If one has an attack on the body, they may never recover.
- This type of MS is progressive from the beginning and is different from RRMS because individual may never come back to normal self.
- Most rare type (10% of cases)
RRMS - Relapsing-Remitting MS
These individuals have “attacks” that come and go. 80-85% of MS cases are RRMS which is slow and progressive and predominately seen in females
Why do people with MS feel fatigue and weak?
Their immune system is always fighting and they are leaking electrical energy needed to move because of decreased electrical transmission of nerve fibers
Secondary-Primary Progressive
As the disease carries on, eventually the disease progresses. An attack that occurs later on in the disease course does not go back into remission/never goes back below clinical threshold (attacks remain).
- 80% of RRMS
McDonald Clinical Criteria: RRMS-Definitive Diagnosis
2 clinical attacks where each attack lasted greater than 24 hours, each at least 30 days apart AND does not require a positive MRI
What is the definitive diagnosis of RRMS in terms of MRI Criteria?
- patient must have 3 our of 4 criteria for MRI (types of lesions) to fulfill dissemination in space criteria OR MRI criteria depicting dissemination in time +1 clinic attack
If an individual has 1 attack that lasted greater than 24 hours, with a +/- MRI that doesn’t fulfill McDonald criteria in regard to dissemination in time and/or space, is this a definitive diagnosis of MS?
No
How do immunomodulatory (IMA) Therapy for RRMS work?
generally work to suppress inflammatory TH1 production that is the hallmark characteristic of MS
