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NEURO 411 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

TRUE or FALSE: MS affects an older population

A

FALSE: younger population

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2
Q

What percentage of MS is pediatric? What percentage of MS patients have an onset or less than or equal to age 18?

A
  • 6% total
  • 3-10% under 18
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3
Q

Does MS affect males or females more?

A

females

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4
Q

TRUE or FALSE: there is decreased axonal density in MS plaques

A

TRUE

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5
Q

What are the causes of MS?

A
  • genes
  • infections (mono)
  • sun
  • smoking
  • salt???
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6
Q

Which gene is associated with MS?

A

HLA

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7
Q

How is EAE produced and transmitted in animals?

A
  1. mice injected with myelin basic protein (MBP) and complete Freund’s adjuvant develop demyelinating disease (EAE)
  2. disease is mediated by myelin basic protein-specific TH1 cells
  3. disease can be transmitted by transfer of T cells from affected animal
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8
Q

Explain the model of molecular mimicry

A
  1. inject virus with MBP
  2. antigen presentation of virus to naive T cells
  3. expansion of virus-specific T cells + expansion of cross-reactive MBP-specific T cells
  4. enter CNS, recognize MBP, initiate inflammatory damage
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9
Q

What cells do CD4 T cell differentiate into in the CNS. What are the associated cytokines?

A
  • TH1–> IL-2, IK-12, IFN-gamma, TNF-alpha
  • TH17 –> IL-17, IL-23
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10
Q

What cells do CD4 T cells differentiate into in the respiratory system? What are the associated cytokines?

A
  • TH2 –> IL-4, IL-5, IL-10, IL-13, IL-25, TGF-beta
  • Treg –> TGF-beta, IL-10, IL-35
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11
Q

There is _____________ inflammation in MS plaques

A

peri-vascular

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12
Q

What pathogenetic events occur in MS?

A
  • inflammation
  • ionic imbalance and increased sodium levels
  • microglia activation
  • energy failure
  • glutamate excitotoxicity
  • astrocyte activation
  • neuro-axonal degeneration
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13
Q

TRUE or FALSE: axonal transection in acute MS lesions can be remyelinated

A

FALSE

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14
Q

What is MS triggered by?

A

inflammation

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15
Q

Describe neurodegeneration in MS pathogenesis.

A
  1. mitochondrial injury leads to energy deficiencies
  2. oxidative stress leads to demyelination
  3. ionic imbalance due to glutamate excitotoxicity
  4. atrophy and degeneration
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16
Q

TRUE or FALSE: myelin loss and axon loss increase with the clinical course of MS

A

TRUE (see slide 27 chart?)

17
Q

How do ocular lesions in MS manifest?

A
  • blurred vision
  • diplopia
18
Q

How do cerebellar lesions in MS manifest?

A
  • ataxic walk
  • vertigo
  • nystagmus
19
Q

How do autonomic lesions in MS manifest?

A
  • urinary incontinence
  • sexual disorders
20
Q

How do motor lesions manifest in MS?

A
  • reduced strength and activity
  • muscle spasms
  • muscle weakness and loss of strength
21
Q

How do sensory lesions manifest in MS?

A
  • sensory loss
  • hypesthesia
22
Q

Why is it important to localize the lesion in MS before prognosis?

A

neurological symptoms depend on where the lesion is

23
Q

Which reflex is primarily affected in MS?

A

motor reflex arc –> leads to spasticity

24
Q

What is the definition of fatigue?

A

a feeling of physical tiredness and lack of energy distinct from sadness or weakness

25
Q

Fatigue is severe in up to ____% of patients.

A

74

26
Q

What is the worst symptom of MS in 50-60% of patients?

A

fatigue

27
Q

What percentage of MS patients are affected by bladder dysfunction? What are some forms of bladder dysfunction?

A
  • 75% of patients
  • bladder overactivity: urgency, frequency, urge incontinence
  • bladder inefficiency: incomplete emptying, residual urine
  • detrusor-sphincter dyssynergia: co-contraction of bladder and urethral sphincter
28
Q

Which fibers innervate the bladder?

A
  • sympathetic
  • parasympathetic
  • somatic
29
Q

What percentage of MS patients are affected by pain? In what ways can it present in MS?

A
  • 40-50%
  • PERSISTENT NEUROGENIC PAIN: burning dysesthesia of the limbs and/or trunk attributed to disruption of the SPINOTHALAMIC pathway
  • PAROXYSMAL NEUROGENIC PAIN (trigeminal neuralgia): excruciating facial pain
30
Q

Which cranial nerve is compressed in trigeminal neuralgia?

A

cranial nerve V (all 3 regions)

31
Q

What do existing treatments for MS primarily target?

A

inflammation

32
Q

What are the 3 main aspects of MS that should be targeted?

A

inflammation, neurodegeneration/demyelination, failure of repair/gliosis

33
Q

There is a need for novel agents that directly target ___________.

A

PROTECTION and REPAIR of the CNS as well as targeting INFLAMMATION

34
Q

What are traditional injectables for MS?

A
  • beta-interferons (IFN-beta)
  • glatiramer acetate
35
Q

What are some oral therapies for MS?

A
  • dimethylfumarate (DMF)
  • fingolimod
  • teriflunomide
  • cladribine
36
Q

What are some monoclonal antibodies for treating MS?

A
  • natalizumab
  • alemtuzumab
  • ocrelizumab
  • ofatumumab
37
Q

What are some chemotherapies for MS?

A
  • mitoxantrone
  • cyclophosphamide
38
Q

What is an experimental MS therapy option as of 2023?

A

autologous stem cell transplant

39
Q

What is the mechanism of action for IFN-beta in treating MS? How effective is it?

A
  • IFN-beta inhibits antigen presentation and T cell activation via IFN-beta receptor
  • decrease pro-inflammatory TH1 cytokines
  • nonspecific but effective, also side effects

NEURO 411 (12 decks)

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