Multiple Sclerosis Flashcards
MS is the most common chronic CNS disease in young adults. It is more common in _____________ and age of onset is _____________.
females
18-40
What are the etiologies of MS?
- measles -antibodies found in serum and CNS of MS lies dormant > activates > autoimmune response
- Herpes
- EBV
- environmental- vit d deficiency
- autoimmune
- Genetic incidence is 8-20x higher in first degree relatives with MS
- increase salt intake
What is the pathophysiology of MS? (its an autoimmune disease)
immune system damages/destroys myelin sheath > myelin is replaced by plaques > nerve dysfunction > myelin affected but also causes damage to nerve- both white and gray matter
The plaques affect…
1 optic nerves
2. other cranial nerves
3. cerebral hemispheres
4. brainstem
5. cerebellum
6. spinal cord
MS usually follows patterns of relapses. How do they occur? They are then followed by periods in which symptoms diminish (remissions)
The average exacerbation is _________________ if untreated
exacerbation over or equal to 24 hrs, separated from last episode by at least 1 month, occurs in the absence of environmental, infectious, or metabolic causes
0.8-1.2 yrs
What are the most common initial presentation?
sensory deficits and fatigue
Optic nerve/ optic neuritis is present in 80% of patients that have visual manifestations of MS. What is the clinical presentation?
monocular visual impairment (common early sign), blurred vision, impaired color vision.
local eye pain
scotomas and visual field defects
marcus gunn pupil
disc pallor
Spinal cord/Myelitis also is affected in MS what is the clinical presentation?
numbness/tingling, decreased vibration and proprioceptive are the common early signs.
Lhermitte’s sign: transient electric shock like pain down into extremities with passive neck flexion.
Bladder dysfunction
hyperflexia and babinski
Brainstem and cerebellum also is affected in MS what is the presentation?
diplopia, ataxis, facial numbness or neuralgia, unilateral face twitch, dysarthria, dysphagia, vertigo and nystagmus, intention tremor
Cerebral hemispheres and general MS presentation
depression, issues with cognition, euphoria, dementia, hearing loss, fatigue (most common)
What is uhthoff’s phenomenon?
exposure to hot environments can trigger MS flare.
Classification of MS:
- benign:
- **relapsing-remitting (RR-MS): **
- primary progressive (PP-MS):
- secondary progressive (SP-MS)
- progressive-relapsing (PR-MS)
- mild relapses, minimal disability
- most common in young ( <40) this one is most common
- slow progression. primary drugs less effective.
- relapsing-remiting that worsens. most convert to RR-MS
- exacerbations without significant recovery
What are the three related disorders and variants of MS?
- optic neuritis: isolated
- transverse myelitis: inflammation of the spinal cord
- neuromyelitis optica: inflammation of spinal cord and optic nerves
How is MS diagnosed?
classical: symptoms and signs are separated both anatomically and in time
history: 2 or more exacerbations/remissions separated in time or progressive course.
PE: evidence of lesions in 2 or more sites.
Mcdonald criteria: # attacks, #locations, MRI and lab findings
Primary care and mcdonald criteria gold standard imaging
MRI brain and spinal cord - plaques and axonal loss
Mcdonald criteria lab
LP with electrophoresis- increase in IgG and oligoclonal bands (indicative of MS)
What is the treatment of an acute attack?
no cure
suppression of immunologically induced inflammatory response.
high dose parenteral corticosteroids- methypred followed by oral prednisone tapor. oral prednisone alone not found to be helpful
MS disease modifying therapy for the relapse-remitting MS
immunodulators, address inflammation.
interferon beta -1b SC
interferon beta 1 a SC
glatirameter acetate, GA (copaxone) SC
MS treatment for progressive disease
mitoxantrone
cyclophosphamide
monoclonal antibiodies
IVIG/plasmapheresis
What is the biggest ADRs from the meds?
progressive mutifocal leukencephalopathy (PML)
Management of complications such as:
1. emotional lability/depression
2. spasticity
3. incontinence
4. bladder atony
5. urinary retention
6. vertigo
7. fatigue
8. walking
- antidepressants
- baclofen
- oxybutinin chloride
- urecholine
- alpha antagonist
- meclizine
- modafnil
- dalfampridine
After 15 years, 50% of patients need help with ______________
while 30% are able to continue walking.
Today, the life expectancy is normal
ambulation
What are predictors for long term disability ?
1.
2.
3.
4.
5.
6.
7.
- incomplete recovery from initial attack
- short interval to 2nd attack
- frequent attacks early in the disease course
- sphincter problems at onset
- motor symptoms at onset
- cerebellar involvement
- late age onset
T/F …
1. Progression of the disease is inevitable
2. there is no cure but disease modifying therapy can reduce relapses and delay progression
- false, it is NOT
- true
MS is a disease of immune dysfunction so patient morale is important because of well documented findings that psychological state can affect _____________________.
t cell function
