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Neuropsychiatric Disorders > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What differences may you see among people with MS?

A

Clinical course
Response to treatment
Differences by ethnic groups
Pathological types (maybe)

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2
Q

What are the two types of MS onsets?

A

Relapsing-remitting
Progressive

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3
Q

What might be differentials for MS?

A

Demyelinating conditions (eg neuromyelitis)
CNS inflammation (eg sarcoid)

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4
Q

What is secondary progressive MS?

A

Late stage (after ~15 years) deterioration due to axonal loss/gliosis

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5
Q

What are the classifications of MS?

A

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

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6
Q

What are most genes implicated in MS related to?

A

MHC-T-cell interaction

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7
Q

What does Copaxone do to disrupt the MS process?

A
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8
Q

Which cells release antibodies?

A

B cells

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9
Q

Which cells release inflammatory cytokines?

A

T-lymphocytes

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10
Q

What causes progression I. Multiple sclerosis?

A

Axonal damage (irreversible)
From exposure to NO and inflammatory cytokines
Increased sodium channels = excitoxicity

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11
Q

What is a better indicator of disability in MS? Atrophy or inflammatory markers?

A

Atrophy

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12
Q

Where does axonal transduction happen?

A

In areas of inflammation

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13
Q

What techniques are used for diagnosis?

A

MRI
Immunology
Evoked potentials

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14
Q

What is the basis of MS diagnosis?

A

Lesions disseminated in time or space.

More than one attack
Lesions in more than one area

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15
Q

Where do MS lesions tend to occur?

A

Around the ventricles
Posterior fossa of cerebellum and brain stem
Spinal cord

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16
Q

What contrast is used for MS?

A

Gadolinium

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17
Q

How would one identify inflammation specific to the CNS?

A

Difference in CSF and blood serum antibodies (oligoclonal band patterns)

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18
Q

What percentage of people with MS will have oligoclonal bands ?

A

97%
People without the bends tend to have a better prognosis
But diagnosis would be evaluated in OCB negative people

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19
Q

What is the general risk of MS?

A

~0.1%

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20
Q

What is the risk of MS for someone with a first degree relative?

A

2-3%

21
Q

What is the risk of MS for someone with an identical twin with MS?

A

30%

22
Q

What is the name to female ratio in MS prevalence?

A

2-3F:1M in relapsing remitting
1:1 primary progressive

23
Q

What is the most likely infectious trigger to MS?

A

Epstein Barr Virus

24
Q

Which factors are associated with poor MS prognosis?

A

Older age
Men
Motor/cerebear symptoms
Frequent relapses
Higher lesion load on MRI
Progressive course

25
Q

Which factors are associated with good MS prognosis?

A

Young
Female
Sensory/optic symptoms
Infrequent attacks
Long intervals between attacks

26
Q

What scale is used to measure MS disability?

A

Expanded disability status scale
1-10 (mild symptoms - death)

27
Q

How many attacks does the average MS patient have per year?

A

One

28
Q

What is the most high efficacy (and high risk) therapy for MS?

A

HSCT (70%)

29
Q

What is the most prescribed treatment for MS?

A

DMF
Dimethyl Fumarate

30
Q

What are the three approaches to treatment?

A

Induction
Escalation
Rescue

31
Q

What are first line therapies for MS?

A

Beta interferon (modulates immune response)
Glatarimer Acetate (myelin polymer)

Both pregnancy safe

32
Q

Which oral MS treatment is contraindicated in pregnancy?

A

Teriflunomide

SIP inhibitors (siponimod etc)

33
Q

What types of treatments are there for MS?

A

SIP inhibitors (Siponimod)
Monoclonal antibodies (Natalizumab)
Chemotherapy (Clabridine)
Haematopoetic stem cell transplantation

34
Q

Which patients would be less suitable for Natalizumab?

A

High levels of JC Virus (risk of PML)

35
Q

What drug has been shown to reduce progression in primary progressive MS?

A

Ocrelizumab

36
Q

What is the most efficacious MS treatment?

A

HCST (85%)

37
Q

What percentage of MS patients experience cognitive loss?

A

50%
25% is significant

38
Q

What are causes of neuropathic pain in MS?

A

Trigeminal neuralgia
Limbs
Hug
Trucks

39
Q

What are aggravators of fatigue in MS patients?

A

Realised
Exercise
Heat
Afternoon

40
Q

Who forms the MDT care in MS?

A

Doctors
Nurses
GP
Neurologist
OT
PT
Social services
Professional carers
Support organisations

41
Q

What is the scale for disability in MS?

A

EDSS
1-10

42
Q

How does progression differ between progressive and relapsing remitting?

A

Progressive reaches EDSS 4 faster (10 vs 40 years)
Progressive then slows down compared to relapsing.

43
Q

How does pregnancy affect MS relapse rate?

A

Reduces during pregnancy due to immunosuppression
Recovery of immunity after delivery increases the risk of relapse above baseline

44
Q

Why might statins be used for MS treatment?

A

Anti inflammatory
Reduce risk of brain shrinkage in progressive disease

45
Q

What are factors that a clinician may look at in an MS patient?

A

Gait
Upper limbs
Speech
Swallowing
Bladder/bowels
Sex
Mood
Cognition
Fatigue
Spasms
Pain
Sleep
Work/finances
Family/relationships

46
Q

What is the rate of depression in MS?

A

50% at some stage
15% at any one time

47
Q

What antidepressants may be used for depression in MS?

A

SNRI (pain)
SSRI (anxiety)
TCA (sleep)

48
Q

What is the typical type of cognitive loss in MS?

A

Subcortical
Slowing, apathy, depression

Neuropsychiatric Disorders (15 decks)

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