MULTIPLE SCLEROSIS Flashcards
mulitple areas of white matter inflammation, demyelination, sclerosis
MS
type of onset?
age of peak onset?
unimodal age of onset
20-30 y/o
where is incidence higher?
temperate regions, lower in tropical areas
higher in the north USA than south
• Similar to relapsing-remitting MS in humans
• Induced in susceptible rats by immunizing them with normal
brain/spinal cord tissue, or myelin basic protein
• T-cells initiate the response
what is this?
experimental allergic encephalomyelitis
what lymphocytes are in the CSF indicated for MS?
CD4+CDw29+
TNF is toxic too?
oligocytes
chromosome mostly affected in patients with MS?
MHC on chr 6 gene codes for HLA markers
types of viruses that are believed to cause MS?
EBV, picornaviruses, measles, rubella, mumps, HTLV-1
most cases of MS are of what type?
10%? 5%?
chronic progressive
primary progressive
progressive relapsing
most affected areas of the body?
optic nerve/chiasm spinal cord (lateral/posterior columns)
number one symptom of MS?
fatigue
gold standard of MS diagnosis?
MRI of brain with and without contrast, bright T2, target appearance on T1
laboratory test?
CSF
oligoclonal bands
myelin basic protein
corticosteroids are used for?
acute exacerbations only otherwise, 1 g IV qd (250 mg IV q 6 hr) of solmedrol for 3-5 days
name this prophylaxis:
Glycosylated amino acid almost identical to native interferon
• Appears to have an immunomodulatory effect, inhibits cell migration and cell-mediated inflammation
Interferon-b-1a
name this prophylaxis:
Nonglycosylated, with serine for cysteine substitution
• Mechanism felt to be the same as 1a
Interferon- b-1b
name this prophylaxis:
Random polymer of basic amino acids
glatiramer acetate
name this oral prophylaxis:
sphingosine 1-phosphate receptor modulation
pyrimidine synthesis inhib.
Nrf2 pathway activator
Fingolimod (Gilenya)
Teriflunomode (Aubagio)
Dimethyl fumarate (Tecfidera)
Positive prognostic factors?
- Early onset
- Sensory symptoms at onset
- Female
- Relapsing-remitting course
- Minimal residual disability five years after diagnosis
negative prognostic factors?
- Late (>40 y/o) onset
* Progressive course
