MS Lecture Powerpoint Flashcards
Multiple sclerosis definition
Immune mediated process in which immune system attacks the CNS damaging the myelin sheaths that insulates the nerve itself and oligodendrocytes, damage disrupts the signal resulting in symptoms associated
MS pathophysiology
Autoreactive T cells cross the BBB start a series of cellular reactions secreting proinflammatory cytokines once in the CSF which causes microglia and astrocytes to activate and turn on proinflammatory cytokines that then causes demyelination and axonal injury, also damaging oligodendrocytes so they cannot repair the myelin sheaths
Theories of MS causes (4)
- Geography from equator (less vit D)
- smoking
- obesity
- infections such as epstein barr
MS epidemiology
Age range 20-40 most often to diagnose, more common in females 3:1 ratio, more common in whites
MS presentation (4)
- Episode of vision loss (typically 24 hours)
- one sided numbness
- vertigo of 24 hrs
- fatigue (85% of patients, huge underlying symptom)
Optic neuritis definition, 2 diagnostic studies, is it a diagnosis of MS?
- Blurred vision or vision loss in one eye or both (sometimes just the color) alongside pain with extraocular motion associated with demyelinating damage to the optic nerve
- MRI of orbits, ANA antibody
- Not always associated with MS, about 50%
Relapsing remitting MS
Most common form, 85%, characterized by clearly defined attacks of new symptoms of one sided weakness and numbness which are called relapses, symptoms may be permanent or improve, see periods of stability between relapses, disability accumulates after multiple relapses
Treatment of relapsing remitting MS episode (2)
- Steroids to shorten duration of attack but doesn’t change disease outcome
- treat underlying cause of episode
Secondary progressive MS
A slow progressive worsening of neurological function with or without relapse that is a progression from relapsing remitting episodes (25-40%) usually occurs about 20 years after diagnosis
Primary progressive relapse
15% of MS that sees slow progressive worsening of neurologic function leading to disability that does not occur episodically, can overlap with relapsing remitting MS slightly
Mcdonald criteria and what does it include?
What are the criteria? (2)
Standard to see if individual meets criteria to meet diagnosis of MS and begin treatment
- 2 symptoms of MS that occurred on separate locations (over lifetime) and imaging locations (2 separate locations) (dissemination in space)
- non-enhancing lesions from a long time ago and enhancing lesions from now on an imaging study or oligoclonal bands (dissemination in time)
MS workup (3)
- MRI
- Labs
- Lumbar puncture for oligoclonal bands (helps diagnose but negative doesn’t rule out)
Radiographically isolated syndrome and clinically isolated syndrome
When the Mcdonald criteria are only partially met putting at elevated risk for MS development and requiring further monitoring than other patiens
Primary progressive MS diagnostic criteria (3)
-Evidence of one year progression
one or more T2 lesions characteristic of MS in periventricular, cortical or juxtacortical or infratenntorial areas
-2 or more hyperintense T2 lesions on spinal cord
-Presence of CSF specific oligoclonal bands
Diseases that mimic MS (6)
- Lupus, Sjogren’s, sarcoid
- Infectious
- Endocrine
- Nutritional deficiency
- NMO/MOG: other demyelinating diseases presenting with optic neuritis but feature different antibodies
- Acute disseminating encephalomyelitis (post infectious, acute and rapid presentation)
2 approaches to MS treatment
- Low efficiency start (in good prognosis patients with low relapse, typical clinical picture, and low lesion burden) that may see more relapses
- High efficiency start (in poor prognosis patients with multifocal onset, atypical clinical picture, and many lesions on MRI)
MS treatment principles (4)
- trick immune system
- modify how immune system functions
- decrease immune system function
- keep immune system away from vulnerable sites
Injectible MS treatment examples (2)
- Giatriamer acetate
- Interferons
Oral MS treatment examples and notes about each (3)
- Terifunamide (aubagio): LFT elevation and category X for males and females pregnancy
- Dimethylfumarate (tecfidera): improving efficacy to 40-50%
- Mayzent/fingilmod: more effective, sequester immune cells to lymph nodes, 60-70% effective
Concern with infusion treatments (Natalizumab) for MS
Progressive multifocal leukoencephalopathy viral infection
Multidisciplinary treatment for MS (5)
- muscle relaxants for spasm
- medical marijuana (muscle spasms and nerve pain)
- Urinary symptoms treatment
- Mood treatment
- PT and OT
Comorbidities of MS (5)
- Hypertension
- Diabetes
- hyperlipidemia
- obesity
- sleep apnea
Enhancing lesions on MRI represents …
…Dissemination in time
McDonald Criteria
- 2 or more clinical attacks, with 2 or more lesions objectively obtained= positive
- 2 or more clinical attacks, with 1 lesion objectively obtained and historical evidence of previous= positive
- 2 or more clinical attacks, with 1 lesion objectively obtained and dissemination in space (clinical or MRI)
- 1 clinical attack with 2 or more lesions objectively obtained and dissemination in time (clinical or MRI or CSF)
- 1 clinical attack with 1 lesion objectively obtained and dissemination in space and time
