MS Flashcards
What cell creates the myelin sheath?
Oligodendrocytes
What is the section of myelin sheath or cell known as?
Schwann cell
A signal transfers faster via what?
Nodes of Ranvier
A patient presents with focal weakness of the lower extremity and fatigue, with neuralgia of the limb, balance problems, and spastic paralysis. What diagnosis?
MS
If a patient was experiencing MS symptoms with their vision, what would they complain of?
Optic neuritis, blurred or diminished vision, blind spots (centrally), pain with eye movement (internuclear opthalmoplegia), sudden color blindness, impaired night vision.
What are some features that are NOT related to MS?
Steady progression or deficit within months, onset before 10 or after 50, cortical deficits (aphasia, alexia, neglect), rigidity, convulsions, dystonia, early dementia.
What is MS?
An autoimmune disease (we think) which causes inflammation with multiple foci of demyelination of the CNS white matter
What is the pathogenesis behind MS?
CNS’s immunoglobulin production disorder with altered T lymphocytes; attack axons, demyelinate them, and reduce the neurons ability to function.
Who do we typically see MS in?
Young adults (20-30), women > men
If MS develops in an older person, what is likely to occur?
It will be more severe
What are the 4 different forms of MS?
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
How do we classify the disease severity of MS?
Benign – fully functional in all neuro symptoms 15 years after onset
Malignant – rapidly progressive, significant disability
What are the risk factors to developing MS?
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)
What is a classic presentation of MS?
Relapse and remission
What is the Lhrmitte’s sign?
Flexion of the neck = electrical sensation that runs down the back into the limbs
What is the Uhthoff’s phenomenon?
Worsening of symptoms in hot water, hot tubs, and with exercise
What imaging must you perform to diagnose MS?
MRI with gadolinium – looking for a cerebral or spinal plaque
What is the criteria for diagnosing MS, and what is it called?
McDonald criteria
Must show 2 or more different areas of affected white matter at different times
What are the areas we look at on an MRI when diagnosing MS?
Periventricular (right along ventricles), juxtacortical (along the cortical area), infratentorial (within the cerebellum), and/or spinal cord
What labs do we perform when diagnosing MS?
Lumbar puncture must be performed but is NOT diagnostic
Looking for = Lymphocytosis, IgG, albumin (indicates disruption of BBB), and oligoclonal bands
What other types of tests can be done to help diagnose MS?
Visual tests are best! Somatosensory (to help evaluate nerve transmission)
How do we treat MS?
There is no cure, just improve the quality of life/relapses
So what help can we offer during acute attacks of MS?
Glucocorticoids; plasma exchange if no response to corticosteroids
What can we offer to decrease the frequency of relapses with MS?
Interferon (injectable), glatiramer (injectable), Fingolimod (first oral agent), Teriflunomide (second oral agent)
What should you always check for when prescribing an interferon? Do you need to do the same lab work for Glatiramer?
LFT’s, CBC, and for neutralizing antibody formation (which would limit the effectiveness of the treatment)
No need for lab work for Glatiramer
What medication causes the T-cells to sequester in lymphoid tissue, so that they can’t attack the myelin?
Fingolimod
Which medication is pregnancy class X, and can stay in your system for 2 years after completion (even in semen)?
Teriflunomide
What 2 medications are for more intense progressive treatment for MS?
Natalizumab (one year only) & Mitoxantrone
