Multiple Sclerosis Flashcards
What are some key facts about MS?
-1/800 of adult population
-Most common cause of neurological disability in
young adults
-Young onset, long duration, limited effect on mortality results in a significant proportion of people with severe disability.
-50 % gait assistance after 10-15 years.
How is MS classified?
-Relapsing remitting MS (RRMS)
-Secondary progressive MS (SPMS)
-Primary progressive MS (PPMS)
-Clinically isolated syndrome (CIS)
What is relapsing remitting MS?
In relapsing remitting MS, people have distinct attacks of symptoms which then fade away either partially or completely.
What is secondary progressive MS (SPMS)?
Secondary progressive MS (SPMS) is a stage of MS which comes after relapsing remitting MS for many people. With this type of MS your disability gets steadily worse.
What is primary progressive MS (PPMS)?
Primary progressive MS affects about 10-15% of people diagnosed with MS. It has this name because from the first (primary) symptoms it is progressive. Symptoms gradually get worse over time, rather than appearing as sudden attacks (relapses).
What is clinically isolated syndrome (CIS)?
In the years before they’re diagnosed with MS, it’s possible that some people may get a diagnosis of one of two syndromes. These are clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS). Lots of people are diagnosed with these and never go on to get MS. But for some they’re an early sign that they’ll later develop MS.
What are the 4 pathological patterns of MS?
MS is not the same pathological process in everyone
I Inflammation & remyelination
II Inflammation & antibody/ complement
III Oligodendrocyteapoptosis
IV Oligodendrocyte damage including normal appearing tissue
What is multiple sclerosis?
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) characterized by chronic inflammation, demyelination, gliosis, and neuronal loss.
What is the pathophysiology of MS?
Two fundamental processes constitute general pathological process seen in MS patients:
-Focal inflammation resulting in macroscopic plaques and injury to the blood-brain barrier (BBB)
-Neurodegeneration with microscopic injury involving different components of the CNS including axons, neurons, and synapse
How is axonal damage relevant to MS?
-Axonal loss is greatest in
areas of active demyelination
but also occurs in normal
appearing white matter
-axons die early in the course of the disease
-Greater correlation between atrophy/ axonal loss
and disability
-Axonal transection occurs predominantly in areas of inflammation
How is MS diagnosed?
-MRI
-Immunology
-Evoked Potentials
What are the principles of diagnosis?
Dissemination in
-Time i.e. more than 1 attack
-Space lesions in more than 1 area
Clinically separate syndromes
MRI
Independent immune attack in CNS
Exclude mimics
What does MRI show in MS patients?
-Inflammatory lesions- diagnosis
-New inflammatory lesions and gadolinium
enhancing lesions = new activity
-T1 Black holes and atrophy = marker of disability
What is the McDonald criteria for MS?
-Dissemination in space: T2 lesion or more in at least two MS typical CNS regions: periventricular, juxtacortical, infratentorial and spinal cord.
-Dissemination in time: simultaneous asymptotic contrast-enhancing and non-enhancing lesions at any time OR a new T2 and/or contrast-enhancing lesion (s) on follow-up MRI, irrespective of timing OR await a second clinical attack
How are CSF oligoclonal bands relevant to MS?
-Evidence of independent production of antibodies within the blood- brain barrier
97% of PwMS
-OCB negative patients tend to have a better prognosis
Not exclusive to MS- also with other infectious/ inflammatory conditions
