MS GUEST LECTURE

Question 1

2017 McDonald Criteria for MS

Answer 1

diagnosis with MRI

DISSEMINATION IN SPACE:
-lesions in 2 of 4 areas:
-periventricular
-brainstem
-juxtacortical
-spinal cord

DISSEMINATION IN TIME:
-need multiple relapses/new lesions
-need active and nonactive lesions
-inflammatory CSF

• 90% of the brain lesions are asymptomatic
• we consider all new lesions to represent new relapses

Question 2

Does inflammatory activity go up or down as the disease duration progresses?

Answer 2

inflammatory activity goes down as disease duration increases

WHEREAS brain volume decreases over time

Question 3

relapse vs pseduorelapse

Answer 3

relapse:
> or equal to 1 symptom from MS with objective neurological deterioration lasting at least 24 hours in the absence of fever and following a neurologically stable period of at least 30 days

pseudorelapse: brief flare-up of old symptoms
caused by anything that temporarily raises affects nerve
transmissions, such as a urinary tract infection, a cold or other virus, exertion during exercise, or high heat and humidity.

Question 4

Differential diagnosis conditions

Answer 4

acute disseminated encephalomyelitis
neuromyelitis optica
sarcoid
collagen vascular diseases
vasculitis
paraneoplastic antibodies

Question 5

Hallmarks of MS pathology

Answer 5

mononuclear inflammatory cells
demyelination
relative axon sparing
astrocyte hypertrophy
cervical spinal cord is disproportionately involved
periventricular lesions

PERMANENT DISTABILITY= NEURONAL LOSS

Question 6

Symptoms of MS depend on the location of:

Answer 6

LESIONS

Question 7

With transverse myelitis and two or more brain lesions on the first occurrence of a partial myelitis

Answer 7

there is an 88% chance of conversion to MS in the next 20 years

Question 8

There is often a huge disconnect between the MRI appearance and the _______

Answer 8

clinical appearance

Question 9

characteristics of lesions in MS

Answer 9

often ovoid and perpendicular to ventricles

Question 10

What brain areas are commonly atrophied in advanced MS?

Answer 10

corpus callosum and cortex

Question 11

CSF in MS

Answer 11

increase myelin basic protein- not specific
-elevated intrathecal IgG, IgM (immunoglobulin)

Question 12

Sun exposure and potential exposure to MS

Answer 12

greater sun exposure–> lower risk

MHC vitamin D response element in the promotor region of HLA-DRB1

-the risk of developing MS significantly decreased with increasing baseline levels of serum vitamin D

Question 13

What type of cells are the current target of disease modifying therapies for MS

Answer 13

B CELLS

• Can act as antigen-presenting cells to T cells via MHC

Question 14

LOOK TO NOTE SHEET FOR INFO ON DMTS AND MEDS

Answer 14

YEP