MS

Question 1

MS is caused my degradation of _____

Answer 1

myelin

Question 2

How many MS patients are there in the US?

Answer 2

400k

Question 3

What latitude is at high risk of MS?

Answer 3

northern/ cool climates (possible vitamin D link)

Question 4

Genetic risk assc with MS

Answer 4

20-40x risk if 1st degree relative has MS

Question 5

Acute treatment of optic neuritis

Answer 5

1 gram IV prednisone 3-5 days

for quicker improvement but no clear impact on longterm improvement

Question 6

What is needed to diagnose MS in the absence of symptoms?

Answer 6

-positive brain MRI
-positive spinal cord MRI
-positive CSF
(2/3 needed)

Question 7

CSF findings in MS

Answer 7

1) oligoclonal banding
2) high IgG/ albumin ratio
3) high IgG synthesis

Question 8

What are traditional (platform) agents for treating MS?

Answer 8

1) interferons
2) glatiramer (copaxone)

• *No evidence to combine the two
• *Medicaid prefers copaxone first

Question 9

Disadvantages to traditional agents for MS?

Answer 9

1) injections
2) incomplete efficacy
3) neutralizing Abs
4) ADRs/ adherence

Question 10

What are three new MS oral therapies?

Answer 10

1) fingolimod (gilenya)
2) teriflunomide (augbagio)
3) dimethyl fumarate (tecfidera)

Question 11

Gilenya/Fingolimod:

• MC ADR
• Most dangerous ADR

Answer 11

1) MC headache

2) dangerous: bradycardia, hypotension- first dose must be monitored

Question 12

Teriflunomide:

compatible with pregnancy?

Answer 12

• must be removed from system with cholestyramine if woman becomes pregnant

Question 13

Common ADRs assc with Teriflunomide (auba-by-gio)

Answer 13

• diarrhea
• alopecia
• hepatotoxic

Question 14

Dimethyl fumarate (tecfidera) common side effects

Answer 14

flushing
diarrhea
nausea

Question 15

Natalizumab is the most effective drug for MS but is second line why?

Answer 15

1/1000 risk of PML

*can test patients for PML Ab to predict risk before starting drug (2% risk conversion)

Question 16

Transverse myelitis: define

Answer 16

demyelination of the spinal cord

Question 17

Variant of MS that fails to respond to DMARDs

Answer 17

Primary Progressive MS

Question 18

Neuromyelitis Optica:

aka

Answer 18

Devics Disease

Question 19

NMO: location of lesions

Answer 19

spinal cord+ optic nerves

loss of vision, loss of sensation, bladder dysfunction

Question 20

NMO Ab

Answer 20

IgG against aquaporin 4 (chloride channel)

Question 21

Tx NMO

Answer 21

Rituximab (CD20 Ab)

Question 22

Which is more severe: NMO or MS

Answer 22

NMO

Question 23

Classic MRI finding in NMO

Answer 23

very long central necrotic region in cord MRI

Question 24

NMO CSF findings

Answer 24

no bands

Question 25

Is co-existing autoimmune disease more common in NMO or MS?

Answer 25

NMO

Question 26

Treatment for spasticity

Answer 26

-baclofen -benzos -tizanidine (all= fatigue)

Question 27

Treatment for neuropathic pain

Answer 27

1) amitryptiline (Elavil) 2) gabapentin (Neurontin) 3) pregabalin (lyrica) 4) carbamazepine (tegretol) 6) duloxetine (Cymbalta)

Question 28

Cognitive domain usually spared in MS

Answer 28

language and verbal skills

Question 29

What causes ^^ risk of cognitive dysfunction in MS

Answer 29

- large T2 lesion area - large T1/2 lesion load - greater number of juxtacortical lesions

Question 30

What improves cognitive symptoms in MS?

Answer 30

stimulants, not alzheimers drugs

Question 31

How is urinary retention treated in MS?

Answer 31

alpha blockers | catheterization (intermittent)

Question 32

How is failure of bladder to store treated in MS?

Answer 32

1) scheduled voiding, limit fluids/diuretics 2) anticholinergics 3) botox in bladder