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OMS - 2 Neuro Final > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Define multiple sclerosis

A

inflammation that leads to myelin destruction and causes clinical symptoms such as motor, sensory and cognitive dysfunction

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2
Q

Multiple sclerosis: most commonly affected population

A

Women between the ages of 20 and 30

(M:F = 1:2)

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3
Q

In which parts of the world is multiple sclerosis incidence the highest?

A
  • Highest incidence in Northern Europeans
  • Lowest incidence in blacks and Asians

(The farther you go from the equator, the more incidents)

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4
Q

Virus that increases the risk of multiple sclerosis

A

EBV

(no association with Hep B vaccine & MS)

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5
Q

Bacteria that increases risk of MS

A

Chlamydia

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6
Q

Risk factors associated with MS

A
  1. Smoking (increases risk by 1.5xs & makes it worse)
  2. Low vitamin D
  3. Genetics: HLA-DR B1
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7
Q

What is the risk of the average person developing multiple sclerosis?

A

1 in 750 (0.1%)

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8
Q

What is the risk of developing multiple sclerosis when a first-degree relative has it?

A

Absolute risk < 5%

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9
Q

What is the risk of developing Multiple sclerosis if your twin has it?

A
  • Monozygotic 31%
  • Dizygotic 5%
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10
Q

What genetically has shown to be associated with the risk of MS

A

HLA-DR2 (chromosome 6)

(no commercial test available)

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11
Q

What are the three pathological processes that take place in multiple sclerosis (in order)?

A
  1. Inflammation
  2. Demyelination
  3. Axon loss
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12
Q

Describe the inflammatory process of multiple sclerosis?

A

Inflammatory cytokines cause the passage of and activation of inflammatory cells into the brain parenchyma

(break down in the BBB)

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13
Q

Describe the demyelination process of multiple sclerosis pathology

A

Activated Th1 cells will lead to the activation of microglial cells and immune cells to attack myelin and a oligodendrocytes and destroy the myelin on the axon

(axonal demyelination → death of axon; they ball up and cause plaques)

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14
Q

Types of multiple sclerosis (4)

A
  1. Clinically isolated syndrome
  2. Relapsing-remitting (RRMS)
  3. Secondary Progressive (SPMS)
  4. Primary Progressive (PPMS)
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15
Q

Multiple sclerosis: CSF findings

A
  1. IgG index
  2. Oligoclonal bands
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16
Q

Multiple sclerosis: differential diagnosis (9)

A
  1. migraine (most common)
  2. NSWMD (nonspecific white matter disease)
  3. small vessel ischemic dz
  4. psych issue
  5. NMO
  6. fibromyalgia
  7. Radiologicaly isolated syndrome
  8. spondylopathy
  9. neuropathy
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17
Q

How long do patients with multiple sclerosis carry a misdiagnosis for on average? What are they usually diagnosed with first?

A
  • 3-9 years (30%) & 10-20 years (26%)
  • migraine→ fibromyalgia→abnormal MRI→psychogenic→NMOSD (neuromyelitis optic spectrum disorder)
18
Q

Multiple sclerosis: ocular manifestation (3)

A
  1. Optic neuritis
  2. Afferent pupillary defect
  3. Diplopia - INO

(INO = inter-nuclear ophthalmologic)

19
Q

Multiple sclerosis: MRI findings

A
  • White matter lesions (signs of aging)
  • Black holes & progressive cases
20
Q

What are some clinical features that are noted not to be suggestive features of MS?

A
  1. steady progression
  2. onset before age 10 or after age 50
  3. cortical deficits such as aphasia, apraxia, alexia, neglect
  4. rigidity, sustained dystonia
  5. convulsions
  6. early dementia
  7. deficit developing within minutes
21
Q

White matter lesions differential diagnosis (5)

A
  1. toxic/metabolic issues
  2. inflammation
  3. infection
  4. trauma
  5. hereditary leukodystrophy
22
Q

what are some prevalent causes of periventricular white matter abnormalities found in people over 65?

A
  1. lyme dz
  2. SLE
  3. MS
  4. vascular causes (small vessel)

(also normal aging)

23
Q

What 4 areas of the CNS does MS typically involve?

A
  1. corpus callosum
  2. temporal lobes
  3. brainstem/cerebellum
  4. spinal cord* 90% in MS (rare in normal aging and small vessel dz
24
Q

Describe the MS lesions seen on MRI.

A

only a couple of segments

(BBB opens up & the T cells rush in → lesions; then they regress)

25
Q

Evoked potentials

(for MS dx)

A

measuring how fast the sensory nerves transmit signal

???????

26
Q

3 routes of admin for MS meds?

A
  1. injections
  2. oral
  3. infusions
27
Q

Rx for MS

A

Tysabri

(reduces lesions, slows disability & relapse rate)

28
Q

4 Clinically isolated syndrome sx

A
  1. ON
  2. transverse myelitis
  3. brainstem syndrome
  4. cerebellar syndrom
29
Q

Brainstem syndrome (3 sx)

A
  1. diplopia
  2. face numbness/weakness
  3. dysarthria
30
Q

CIS or MS attack tx in ER (4)

A
  1. abx
  2. spinal tap
  3. IgG
  4. oligoclonal banding (OCB)
  5. IVMP (????)
31
Q

Goals of MS tx

A

reduce MRI activity

(also slow disease, relapse, maintain adherence)

32
Q

How do you follow MS patients disease progression?

A

yearly MRIs

33
Q

Biomarkers for MS (4) indicating a change in Rx

A
  1. Ab to IFN
  2. Aquaporin-4 (for neuromyelitis optica)
  3. Myelin oligodendrocyte glycoprotein (MOG)
  4. JC virus Abs
34
Q

Rx for MS w/JC Virus

A

Tecfidera

(maybe tysabri 12 months)

35
Q

3 Clinical indicators of MS progression

A
  1. continued attacks w/meds
  2. new lesions
  3. relapses
36
Q

Primary Progressive MS Tx (PPMS)

A

Ocrevus

37
Q

Secondary progressive MS (SPMS)

A

immunosuppression

(IVIG, plasma exchange, bone marrow transplant)

38
Q

SPMS w/attacks Tx (4)

A
  1. Tecfidera
  2. Tysabri
  3. Mavenclad
  4. Mayzent
39
Q

What can make MS symptoms worse (2)

A
  1. heat
  2. infection
40
Q

Neuromyelitis optica tx

A

Rituxan

(other immunosuppressants)

OMS - 2 Neuro Final (36 decks)

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