Multiple Sclerosis Flashcards
What differences may you see among people with MS?
Clinical course
Response to treatment
Differences by ethnic groups
Pathological types (maybe)
What are the two types of MS onsets?
Relapsing-remitting
Progressive
What might be differentials for MS?
Demyelinating conditions (eg neuromyelitis)
CNS inflammation (eg sarcoid)
What is secondary progressive MS?
Late stage (after ~15 years) deterioration due to axonal loss/gliosis
What are the classifications of MS?
Relapsing-remitting MS
-relapsing-remitting stage
-secondary progressive stage (non-relapsing)
-secondary progressive stage (relapsing)
Primary progressive MS
-primary progressing non-relapsing
-primary progressive relapsing
What are most genes implicated in MS related to?
MHC-T-cell interaction
What does Copaxone do to disrupt the MS process?
Which cells release antibodies?
B cells
Which cells release inflammatory cytokines?
T-lymphocytes
What causes progression I. Multiple sclerosis?
Axonal damage (irreversible)
From exposure to NO and inflammatory cytokines
Increased sodium channels = excitoxicity
What is a better indicator of disability in MS? Atrophy or inflammatory markers?
Atrophy
Where does axonal transduction happen?
In areas of inflammation
What techniques are used for diagnosis?
MRI
Immunology
Evoked potentials
What is the basis of MS diagnosis?
Lesions disseminated in time or space.
More than one attack
Lesions in more than one area
Where do MS lesions tend to occur?
Around the ventricles
Posterior fossa of cerebellum and brain stem
Spinal cord
What contrast is used for MS?
Gadolinium
How would one identify inflammation specific to the CNS?
Difference in CSF and blood serum antibodies (oligoclonal band patterns)
What percentage of people with MS will have oligoclonal bands ?
97%
People without the bends tend to have a better prognosis
But diagnosis would be evaluated in OCB negative people
What is the general risk of MS?
~0.1%
What is the risk of MS for someone with a first degree relative?
2-3%
What is the risk of MS for someone with an identical twin with MS?
30%
What is the name to female ratio in MS prevalence?
2-3F:1M in relapsing remitting
1:1 primary progressive
What is the most likely infectious trigger to MS?
Epstein Barr Virus
Which factors are associated with poor MS prognosis?
Older age
Men
Motor/cerebear symptoms
Frequent relapses
Higher lesion load on MRI
Progressive course
Which factors are associated with good MS prognosis?
Young
Female
Sensory/optic symptoms
Infrequent attacks
Long intervals between attacks
What scale is used to measure MS disability?
Expanded disability status scale
1-10 (mild symptoms - death)
How many attacks does the average MS patient have per year?
One
What is the most high efficacy (and high risk) therapy for MS?
HSCT (70%)
What is the most prescribed treatment for MS?
DMF
Dimethyl Fumarate
What are the three approaches to treatment?
Induction
Escalation
Rescue
What are first line therapies for MS?
Beta interferon (modulates immune response)
Glatarimer Acetate (myelin polymer)
Both pregnancy safe
Which oral MS treatment is contraindicated in pregnancy?
Teriflunomide
SIP inhibitors (siponimod etc)
What types of treatments are there for MS?
SIP inhibitors (Siponimod)
Monoclonal antibodies (Natalizumab)
Chemotherapy (Clabridine)
Haematopoetic stem cell transplantation
Which patients would be less suitable for Natalizumab?
High levels of JC Virus (risk of PML)
What drug has been shown to reduce progression in primary progressive MS?
Ocrelizumab
What is the most efficacious MS treatment?
HCST (85%)
What percentage of MS patients experience cognitive loss?
50%
25% is significant
What are causes of neuropathic pain in MS?
Trigeminal neuralgia
Limbs
Hug
Trucks
What are aggravators of fatigue in MS patients?
Realised
Exercise
Heat
Afternoon
Who forms the MDT care in MS?
Doctors
Nurses
GP
Neurologist
OT
PT
Social services
Professional carers
Support organisations
What is the scale for disability in MS?
EDSS
1-10
How does progression differ between progressive and relapsing remitting?
Progressive reaches EDSS 4 faster (10 vs 40 years)
Progressive then slows down compared to relapsing.
How does pregnancy affect MS relapse rate?
Reduces during pregnancy due to immunosuppression
Recovery of immunity after delivery increases the risk of relapse above baseline
Why might statins be used for MS treatment?
Anti inflammatory
Reduce risk of brain shrinkage in progressive disease
What are factors that a clinician may look at in an MS patient?
Gait
Upper limbs
Speech
Swallowing
Bladder/bowels
Sex
Mood
Cognition
Fatigue
Spasms
Pain
Sleep
Work/finances
Family/relationships
What is the rate of depression in MS?
50% at some stage
15% at any one time
What antidepressants may be used for depression in MS?
SNRI (pain)
SSRI (anxiety)
TCA (sleep)
What is the typical type of cognitive loss in MS?
Subcortical
Slowing, apathy, depression
