MS Flashcards
Does MS affect gray matter?
Somewhat–but mostly white matter
What is the most common type of demyelinating disease?
MS
What is the pathophysiology of MS?
Autoimmune attack against the oligodendrocytes
What is the geographical distribution of MS?
Increased in the temperate zones
What is the ratio of MS in females:males?
2-3:1 females:males
What is the peak age of onset for MS?
33
What virus is present in almost all MS patients?
EBV
Titers of what virus increase with MS?
EBV
What is the risk of developing MS if you have a 1st degree relative?
2-6%
What ethnicity is usually affected with MS?
Caucasians
What is the risk to children if a pt has MS?
1/40
What is the concordance rate between identical twin for MS?
30%
What is the HLA haplotype that is implicated with MS?
HLA-DR2
What is the immunology behind MS?
Predominately an aberrant T-cell mediated disease, caused by activation of circulating CD4 cells specific for myelin basic protein.
These cells are allowed to cross the BBB
What is the outcome of axonal degeneration?
Either heal or terminate
What are the three types of MS? Which is most common?
- Relapsing-remitting
- Primary progressive
- Secondary progressive
What percent of MS patients have a benign course? Intermediate? Malignant?
Benign = 10-20% Intermediate = 70-80% Malignant = 10%
Which gender is a negative prognostic indicator?
Male
Is younger or older age at onset of MS associated with worse outcome?
Older
Symptoms from what part of the brain is a significantly poor prognostic indicator for MS?
Posterior fossa symptoms at onset (cerebellar)
What ethnicity have a worse course of MS?
Blacks
True or false: significant residual disability from the first attack of MS has no prognostic value
False–prognosticates a bad outcome
What are the three majors tests that may be useful in diagnosing MS?
- CSF
- MRI
- Evoked potentials
What exam findings are indicative of MS?
- UMN s/sx
- RAPD
- Disk edema
What is the largest white matter tract in the brain?
Corpus callosum
Lesion in what part of the brain is classic for MS?
Corpus callosum
What is the role of Gadolinium in imaging?
Lights up white matter damage 60 days or less in age
What are the CSF findings of MS? (4)
- Pleocytosis of less than 50 WBC
- Protein elevation
- Elevated IgG synthesis rate
- Oligoclonal IgG bands
What is the visual evoked response test? How helpful is this to diagnose MS?
Measure of how fast information from the optic nerve head travels to the primary visual cortex
What is Devic’s disease (neuromyelitis optica)?
-B-cell mediated inflammatory and demyelinating disease that has a predilection for the optic nerve
What is the blood test for Devic’s disease?
Aquaporin-4 ab (NMO IgG)
What is acute disseminated encephalomyelitis (ADEM)? What usually precipitates the disease? S/sx?
- Rare autoimmune disease marked by a sudden widespread attack of inflammation in the brain and spinal cord.
- Usually brought on after a viral infection
- HA, n/v, coma, vision impairment
What is the use and MOA of fampridine? Major side effect?
- Improves gait in MS patients by blocking K channels, to speed conduction along a demyelinated axon
- Sz
What is the vitamin that MS patients should take?
Vitamin D
What is the major immunomodulation therapy for MS?
Beta-IFN to help modulate the immune system
What are the two antibodies that are used in the treatment of MS?
Natalizumab
Alemtuzumab
What denotes the highest risk of getting MS? What is the chance of getting it?
If both parents have MS–35%
What are the three major receptor interactions between APCs and CD4+ T cells?
CD28 - B7
CD40L and CD40
MHC receptors
What is the role of VCAM-1?
Mediates the adhesion of WBCs to the vascular endothelium
What is the role of ICAM-1 (aka CD54)? What protein does it bind to on WBCs?
Binds to LFA-1 on WBCs
What are the cell signals that upregulate VCAM-1 and ICAM-1? (2)
- TNF-alpha
- IL-1
True or false: H and P is still the mainstay of diagnosis for MS
True
What is the prognosis for acute disseminated encephalomyelitis?
Most recover completely over months
What is the treatment for acute disseminated encephalomyelitis?
Corticosteroids
Does acute disseminated encephalomyelitis (ADEM) usually involve white or gray matter?
Both
Is acute disseminated encephalomyelitis (ADEM) usually monophasic, biphasic, or multiphasic?
Monophasic
What is the MOA Of alemtuzumab? Use?
- CLL, and MS treatment
- Ab against CD52, which targets mature lymphocytes
What is the MOA Of natalizumab? Use? Major side effect?
- IgG against adhesion molecules alpha-4-integrin, to inhibit cells to pass through cell layers of the BBB
- Treats MS and crohn’s disease
- PML
What is the MOA Of daclizumab? Use?
- Prevents organ rejection and MS
- Binds to CD25 (IL-2 receptor on T cells)
