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Pathophysiology > MS > Flashcards

MS Flashcards

1
Q

What are the white spots on brain MRI pictures called?

A

Periventricular lesions

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2
Q

Is MRI an indicator of neurological deficit in MS patients?

A

No, MRI is only a secondary indicator of disease progression because there is no specific correlation between lesion and neurological deficit

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3
Q

what is the incidence of multiple sclerosis?

A

1:500 to 1:1000 (2-3 patients diagnosed every day)

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4
Q

Describe what kind of factors contribute to risk of acquiring MS?

A

Caucasian, 25-38, more prevalent in females, genetic predisposition to develop MS if you have 1st relative with it

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5
Q

What is the ratio of susceptibility to MS in terms of gender, females to males?

A

3:1

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6
Q

Is MS hereditary?

A

No, but one can have a genetic predisposition to it

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7
Q

What does it mean when an individual has a first degree relative who has MS?

A

This individual has absolute risk of MS <5% which equates to 20-40% increased risk compared to the general population

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8
Q

presence of what allele increases the risk of MS?

A

HLA-DR2 allele

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9
Q

What are the 3 theories of MS?

A
  1. Infectious Theory
  2. Molecular Mimicry
  3. Autoimmune Disease
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10
Q

What is the pathological explanation for MS?

A

MS is a chronic neurological auto-immune disorder caused by pathological activation of inflammatory TH1 cells

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11
Q

How do TH1 cells enter the brain?

A

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

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12
Q

what is the median time for someone with MS to require a cane/crutch upon 1st diagnosis?

A

15 years

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13
Q

what is the median time for someone with MS to require wheelchair confinement upon 1st diagnosis?

A

25 years

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14
Q

Does time after diagnosis and initiating treatment have an affect on the degree of disability of an individual over time?

A

Yes, the earlier the treatment, the better. Early intervention may have the greatest potential impact on both pathological and clinical course.

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15
Q

What are clinical diagnostic tools to help diagnose MS?

A
  1. Examination of cerebra-spinal Fluid

2. MRI

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16
Q

what is found in the CSF of MS patients?

A

oligoclonal IgG bands (in >95% patients with clinically definite MS). They tell us whether there are antibodies against oligodendrocytes

17
Q

What are the types of MS?

A
  1. RRMS (Relapsing and Remitting)
  2. CIS (Clinically isolated syndrome)
  3. SPMS (secondary Progressive MS)
  4. PPMS (primary-progressive MS)
18
Q

CIS - Clinically Isolated Syndrome

A

“benign MS” that always stays below baseline. May not need treatment because normal life is not affected

19
Q

PPMS - Primary-Progressive MS

A
  • 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)
20
Q

RRMS - Relapsing-Remitting MS

A

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

21
Q

Why do people with MS feel fatigue and weak?

A

Their immune system is always fighting and they are leaking electrical energy needed to move because of decreased electrical transmission of nerve fibers

22
Q

Secondary-Primary Progressive

A

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

23
Q

McDonald Clinical Criteria: RRMS-Definitive Diagnosis

A

2 clinical attacks where each attack lasted greater than 24 hours, each at least 30 days apart AND does not require a positive MRI

24
Q

What is the definitive diagnosis of RRMS in terms of MRI Criteria?

A
  • 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
25
Q

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?

A

No

26
Q

How do immunomodulatory (IMA) Therapy for RRMS work?

A

generally work to suppress inflammatory TH1 production that is the hallmark characteristic of MS

Pathophysiology (7 decks)

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