MS Flashcards
What is the primary pathology of MS?
Multiple focal sites of demyelination in the CNS
What is the cause of demyelination in MS?
T-cell mediated immune response
What is the trigger of the immune response that causes MS?
Currently unknown
Does the demyelination of MS ever heal?
Yes, but not permanently
What is the typical temporal pattern of MS?
Relapse and remission
Remissions end up getting less and less complete however in progressing disease
Where in the world have the highest rates of MS?
Temperate areas
England, Scotland
T/F MS is more common in blacks/asians
F
Rarer in blacks and asians
If a person lives in a geographical area that has a high risk of MS, then moves to a low risk area and has children, what happens to the risk profile of them and their children?
Their risk will remain high because you take your risk of MS with you
Children acquire the risk of where they settle, so their risk would be low
If a person lives in a geographical area that has a high risk of MS, then moves to a low risk area and has children, what happens to the risk profile of them and their children?
Their risk will remain high because you take your risk of MS with you
Children acquire the risk of where they settle, so their risk would be low
What is the average age of onset of MS?
30 years old
Is MS more common in males or females?
Females
3:1
What role does Vit D seem to play in MS?
Circulating Vit D status relates to improved symptoms and prevention of MS
Early exposure to sunlight/vit D seems to be important, hence the geographical areas of high risk where sunlight exposure is low
What are some major sensory features of MS?
Dysaesthesia
Paraesthesia
Decreased vibration sense
Trigeminal neuralgia
What are some major motor features of MS?
Spastic weakness
Transverse myelitis (loss of motor, sensory, autonomic etc below the level of a lesion)
Does MS lead to erectile dysfunction?
Yes
As well as anorgasmia
Does MS lead to urine or faecal retention?
Yes
Urinary retention and constipation
What are some ophthalmological features of MS?
Optic neuritis
Diplopia
Pupillary defects
What are some cerebellar features of MS?
Trunk/limb ataxia
Intention tremor
Scanning (ie monotonous) speech
Falls
What are some major cognitive features of MS?
Decreased executive functioning
Decreased mood, depression and isolation
What conditions other than MS can cause hyperdense lesions in the CNS?
SLE
Sjogren syndrome
Polyarteritis nodosa
Syphilis
What conditions other than MS can cause hyperdense lesions in the CNS?
SLE
Sjogren syndrome
Polyarteritis nodosa
Syphilis
In what clinical situation would you almost not consider that something other than MS could be causing the symptoms?
young adult who has had two or more clinically distinct episodes of central nervous system dysfunction with at least partial resolution
Diagnostic difficulties arise in patients who have atypical presentations, monophasic episodes, or progressive illness
What are some clinical features that would make you begin to consider that the clinical syndrome was not MS?
Well demarcated spinal cord lesion level, below which are found all of the neurological symptoms
Patient is >60 or
What are some major DDx’s for MS?
Transverse myelitis
Neuromyelitis optica
Acute disseminated encephalomyelitis (ADEM)
What is the major gist of the McDonald criteria for MS diagnosis?
Dissemination of lesions in time and space
If a patient with ?MS only has had one attack with two clinical lesions, what additional data is required by the McDonald criteria?
Dissemination in time
Thus, basically just a 2nd clinical attack with 2 clinical lesions
Or MRI data
If a patient with ?MS only has had one attack with two clinical lesions, what additional data is required by the McDonald criteria?
Dissemination in time
Thus, basically just a 2nd clinical attack with 2 clinical lesions
Or MRI data
If a patient with ?MS only has had one attack, and only with one clinical lesion, what additional data is required by the McDonald criteria?
Dissemination in both time and space
Thus, another clinical attack and evidence that there are multiple lesions on MRI and +ve CSF
Are T2 hyperdense lesions in MS more common in the thalamus or periventricularly?
Periventricular
Thalamic lesions are more common in ADEM
What does an LP look for in MS?
Oligoclonal IgG bands on electrophoresis that are not present in serum
What does an LP look for in MS?
Oligoclonal IgG bands on electrophoresis that are not present in serum
NMO-IgG ab’s in CSF are highly specific for neuromyelitis optica (NMO; Devic’s syndrome)
What is the primary drug used to shorten the time to remission in MS relapses?
Methylprednisolone
How often can you give an MS patient methylprednisolone?
Very sparingly
Maximum of twice per year
Does methylprednisolone change the overall prognosis of MS?
No
Only shortens relapses
What is the role of interferon in MS treatment?
Decreases relapses by 30% in active disease
Decreases lesion accumulation on MRI
What are some serious side effects of interferon treatment?
Flu-like symptoms
Depression
Abortion
What do you know about azathioprine in the treatment of MS?
May be as effective as interferons but much cheaper (20x)
What is natalizumab (Tysabri)?
A monoclonal antibody which allows immune cells to cross the BBB
Decreases MS relapses by 2/3rds and reduces MRI lesions by 90%
