MS Flashcards
What are the contributing factors of MS?
- caucasion
- ages 25-38
- gender (F3:M1)
- infection
- injury
- genetics
- geography
- diet/sunshine
How many Canadians are affected with MS?
- 1/500 - 1/1000 people
- 2-3 people diagnosed every day
Patients with a first order relative with MS have a ____ chance of getting MS, which is ___________ higher than the general population.
<5%
20-40 times
The presence of which allele increase the risk of MS?
the HLA-DR2 allele
What are the 3 theories of MS?
- Infectious theory
- Molecular mimicry
- Autoimmune disease
How does the autoimmune disease theory work?
- APCs grab foreigner antigens that don’t belong
- APCs attach antigen to a T-cell
- T-cell is activated into a Th1 cell so create an inflammatory response
- imbalance of immune system increase pro-inflammatory Th1 cells (Th1>Th2)
- when excess Th1 cells are produced, there is more inflammation
- the inflammation causes the blood brain barrier to become sticky
- the Th1 cell stuck on the BBB will cause more inflammation and will release proteases
- the proteases will break down the BBB and Th1 cells will get into the bloodstream/CNS
What is the median time to requiring a cane/crutch?
Wheelchair?
- 15 years
- 25 years
How can you diagnose MS?
- look at CSF for oligoclonal IgG bands (ABs that eat myelin)
- severe headaches post-CSF sample
- MRI (second-line diagnostic tool)
- looking for spots of demyelination around ventricles of the brain
What is clinically isolated syndrome MS?
- it is a single attack
- may not progress
- may not require treatment
What is relapsing-remitting MS?
- multiple attacks
- recovering from attacks as well
What is secondary progressive MS?
- comes after RRMS
- not getting better after the attacks anymore
ex. vision will blur but won’t go back to normal
What is primary progressive MS?
- first attack, no recovery
- lose vision, doesn’t get bettter
- foot drags, pt never regains control
What are the MS-induced symptoms?
Fatigue/weakness - energy you need to function is leaking through the holes in the myelin, pt is using extra energy to do the same things
Bladder control - no nerve that stops you from wetting yourself, no nerve that sends the signal that you need to pee
NPP - ABs eat away at coating of myelin, you can feel this
Cognitive defects - nerve cells die from being stripped
Optic neuritis - optic nerve affected
Ataxia - balance problems from nerve stripping
Sexual dysfunction
Depression
What does the RRMS definitive diagnosis consist of?-
- clinical attacks +/- MRI showing dissemination in time and space
- 2 clinical attacks that lasted longer than 24 hours
- attacks must be longer that 30 apart
- does not require MRI
- within 2 years
How is clinically isolated syndrome diagnosed?
- 1 attack lasting longer than 24 hours
- EVEN with a +/-ve MRI
- not a definitive diagnosis of MS
