MS

Question 1

What cell creates the myelin sheath?

Answer 1

Oligodendrocytes

Question 2

What is the section of myelin sheath or cell known as?

Answer 2

Schwann cell

Question 3

A signal transfers faster via what?

Answer 3

Nodes of Ranvier

Question 4

A patient presents with focal weakness of the lower extremity and fatigue, with neuralgia of the limb, balance problems, and spastic paralysis. What diagnosis?

Answer 4

MS

Question 5

If a patient was experiencing MS symptoms with their vision, what would they complain of?

Answer 5

Optic neuritis, blurred or diminished vision, blind spots (centrally), pain with eye movement (internuclear opthalmoplegia), sudden color blindness, impaired night vision.

Question 6

What are some features that are NOT related to MS?

Answer 6

Steady progression or deficit within months, onset before 10 or after 50, cortical deficits (aphasia, alexia, neglect), rigidity, convulsions, dystonia, early dementia.

Question 7

What is MS?

Answer 7

An autoimmune disease (we think) which causes inflammation with multiple foci of demyelination of the CNS white matter

Question 8

What is the pathogenesis behind MS?

Answer 8

CNS’s immunoglobulin production disorder with altered T lymphocytes; attack axons, demyelinate them, and reduce the neurons ability to function.

Question 9

Who do we typically see MS in?

Answer 9

Young adults (20-30), women > men

Question 10

If MS develops in an older person, what is likely to occur?

Answer 10

It will be more severe

Question 11

What are the 4 different forms of MS?

Answer 11

Relapsing Remitting – MC, initial episode then months to years before new or return of symptoms

Secondary Progressive – What most patients progress to

Primary Progressive – (less common) Symptoms are steadily progressive from onset

Progressive Relapsing – Has some remission but steady decline

Question 12

How do we classify the disease severity of MS?

Answer 12

Benign – fully functional in all neuro symptoms 15 years after onset

Malignant – rapidly progressive, significant disability

Question 13

What are the risk factors to developing MS?

Answer 13

genetic (HLA-DRB1 association), viral exposure to EBV, and living in a temperate zone (unless you move to a different zone prior to the age of 15)

Question 14

What is a classic presentation of MS?

Answer 14

Relapse and remission

Question 15

What is the Lhrmitte’s sign?

Answer 15

Flexion of the neck = electrical sensation that runs down the back into the limbs

Question 16

What is the Uhthoff’s phenomenon?

Answer 16

Worsening of symptoms in hot water, hot tubs, and with exercise

Question 17

What imaging must you perform to diagnose MS?

Answer 17

MRI with gadolinium – looking for a cerebral or spinal plaque

Question 18

What is the criteria for diagnosing MS, and what is it called?

Answer 18

McDonald criteria

Must show 2 or more different areas of affected white matter at different times

Question 19

What are the areas we look at on an MRI when diagnosing MS?

Answer 19

Periventricular (right along ventricles), juxtacortical (along the cortical area), infratentorial (within the cerebellum), and/or spinal cord

Question 20

What labs do we perform when diagnosing MS?

Answer 20

Lumbar puncture must be performed but is NOT diagnostic

Looking for = Lymphocytosis, IgG, albumin (indicates disruption of BBB), and oligoclonal bands

Question 21

What other types of tests can be done to help diagnose MS?

Answer 21

Visual tests are best! Somatosensory (to help evaluate nerve transmission)

Question 22

How do we treat MS?

Answer 22

There is no cure, just improve the quality of life/relapses

Question 23

So what help can we offer during acute attacks of MS?

Answer 23

Glucocorticoids; plasma exchange if no response to corticosteroids

Question 24

What can we offer to decrease the frequency of relapses with MS?

Answer 24

Interferon (injectable), glatiramer (injectable), Fingolimod (first oral agent), Teriflunomide (second oral agent)

Question 25

What should you always check for when prescribing an interferon? Do you need to do the same lab work for Glatiramer?

Answer 25

LFT’s, CBC, and for neutralizing antibody formation (which would limit the effectiveness of the treatment)

No need for lab work for Glatiramer

Question 26

What medication causes the T-cells to sequester in lymphoid tissue, so that they can’t attack the myelin?

Answer 26

Fingolimod

Question 27

Which medication is pregnancy class X, and can stay in your system for 2 years after completion (even in semen)?

Answer 27

Teriflunomide

Question 28

What 2 medications are for more intense progressive treatment for MS?

Answer 28

Natalizumab (one year only) & Mitoxantrone