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MIMM 214 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

what type of disease is MS and where does it cause effect?

A

chronic autoimmune disease of CNS

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2
Q

what happens to neurons with MS?

A

myelin sheath is destroyed and leaves scar tissue (sclerosis) so nerves cannot pass along their signals

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3
Q

what part of MS does MRI detect?

A

MRI detects lesions of destroyed myelin sheath

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4
Q

describe the steps of MS and the immune system (5)

A
  1. unknown trigger induces inflammation
  2. inflammation causes BBB to become permeable to leukocytes and blood proteins
  3. autoreactive CD4+ T cells encounter their specific CNS autoantigen presented by MHC II on macrophages
  4. further inflammatory reaction occurs in the brain, producing auto-antibodies, mast cells, cytokines, etc.
  5. autoreactive T cells, B cells, and innate cells lead to demyelination
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5
Q

what can regulate inflammation for a little bit?

A

Treg cells

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6
Q

do we normally have autoreactive cells?

A

no they are normally removed from circulation when detected to be autoreactive, but with MS they will stay in circulation

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7
Q

what are the 2 types of MS? which is more common?

A
  1. relapse-remitting MS (85% of patients)
  2. primary progressive MS
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8
Q

what happens during relapse-remitting MS?

A

periods of remission followed by relapse

baseline of remission gets worse with each relapse

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9
Q

what happens during primary progressive MS?

A

continuously gets worse

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10
Q

what are the 4 stages of MS?

A
  1. Radiologically Isolated Syndrome (RIS)
  2. Clinically Isolated Syndrome (CIS)
  3. Relapsing-Remitting MS (RRMS)
  4. Secondary Progressive MS (SPMS)
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11
Q

What happens during stage 1, Radiologically Isolated Syndrome (RIS)

A

Don’t know for sure if it MS, but some MRI activity indicating MS with some MRI lesions

Potential treatment window

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12
Q

What happens during stage 2, Clinically Isolated Syndrome (CIS)?

A

Confirm it is MS, more MRI activity and lesions

Ideal treatment window

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13
Q

What happens during stage 3, Relapsing-Remitting MS (RRMS)?

A

unpredictable patterns of remission and relapsing, lots of MRI activity and lesions

Brain volume starting to decline

Ideal treatment window

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14
Q

What happens during stage 4, Secondary Progressive MS (SPMS)?

A

Continuously getting worse, declining brain volume

Untreatable

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15
Q

what are 8 symptoms of MS?

A
  1. Pain
  2. Fatigue
  3. Tingling
  4. Impaired gait (walking pattern)
  5. Vision problems
  6. Bladder problems
  7. Dizziness
  8. Cognitive and mood problems
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16
Q

how is MS diagnosed? (3)

A
  1. MRI
  2. Observe vision, coordination, sense of balance
  3. Spinal tap or Lumbar puncture (collecting CSF to determine inflammation based on # of auto-ab)
17
Q

what are 2 treatments for MS?

A
  1. IFN beta and corticosteroid therapy
  2. Dimethyl fumarate
18
Q

by what percent do IFN beta and corticosteroids reduce relapse?

A

30%

19
Q

how often is IFN beta and corticosteroid administered?

A

weekly

20
Q

describe potential mechanisms of IFN beta therapy (5)

A
  1. prevent lymphocytes from exiting lymph node so they cannot enter the brain
  2. reduce ability of lymphocytes to cross BBB
  3. affecting APC function
  4. inhibit some T cell differentiation and increase T cell apoptosis
  5. flu symptoms (bc TFN beta is anti viral cytokine)
21
Q

what is the mechanism of corticosteroids?

A

IMMUNOSUPPRESSANT
1. reduce inflammation caused by pro-inflammatory cytokines
2. increased lymphocyte apoptosis
3. reduce migration of leukocytes to brain

22
Q

by what percent does dimethyl therapy reduce relapse?

A

50%

23
Q

how is dimethyl therapy administered?

A

oral pills

24
Q

why could dimethyl fumarate be a better treatment than IFN beta / corticosteroid?

A

newer treatment so there are fewer cytokines

25
Q

what are 2 mechanisms of dimethyl fumarate?

A
  1. anti-inflammatory effects –> suppress production of pro-inflammatory cytokines
  2. may alter DC activation

MIMM 214 (33 decks)

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