Multiple Sclerosis

Question 1

What differences may you see among people with MS?

Answer 1

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

Question 2

What are the two types of MS onsets?

Answer 2

Relapsing-remitting
Progressive

Question 3

What might be differentials for MS?

Answer 3

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

Question 4

What is secondary progressive MS?

Answer 4

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

Question 5

What are the classifications of MS?

Answer 5

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

Question 6

What are most genes implicated in MS related to?

Answer 6

MHC-T-cell interaction

Question 7

What does Copaxone do to disrupt the MS process?

Question 8

Which cells release antibodies?

Answer 8

B cells

Question 9

Which cells release inflammatory cytokines?

Answer 9

T-lymphocytes

Question 10

What causes progression I. Multiple sclerosis?

Answer 10

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

Question 11

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

Answer 11

Atrophy

Question 12

Where does axonal transduction happen?

Answer 12

In areas of inflammation

Question 13

What techniques are used for diagnosis?

Answer 13

MRI
Immunology
Evoked potentials

Question 14

What is the basis of MS diagnosis?

Answer 14

Lesions disseminated in time or space.

More than one attack
Lesions in more than one area

Question 15

Where do MS lesions tend to occur?

Answer 15

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

Question 16

What contrast is used for MS?

Answer 16

Gadolinium

Question 17

How would one identify inflammation specific to the CNS?

Answer 17

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

Question 18

What percentage of people with MS will have oligoclonal bands ?

Answer 18

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

Question 19

What is the general risk of MS?

Answer 19

~0.1%

Question 20

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

Answer 20

2-3%

Question 21

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

Answer 21

30%

Question 22

What is the name to female ratio in MS prevalence?

Answer 22

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

Question 23

What is the most likely infectious trigger to MS?

Answer 23

Epstein Barr Virus

Question 24

Which factors are associated with poor MS prognosis?

Answer 24

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

Question 25

Which factors are associated with good MS prognosis?

Answer 25

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

Question 26

What scale is used to measure MS disability?

Answer 26

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

Question 27

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

Answer 27

One

Question 28

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

Answer 28

HSCT (70%)

Question 29

What is the most prescribed treatment for MS?

Answer 29

DMF Dimethyl Fumarate

Question 30

What are the three approaches to treatment?

Answer 30

Induction Escalation Rescue

Question 31

What are first line therapies for MS?

Answer 31

Beta interferon (modulates immune response) Glatarimer Acetate (myelin polymer) Both pregnancy safe

Question 32

Which oral MS treatment is contraindicated in pregnancy?

Answer 32

Teriflunomide SIP inhibitors (siponimod etc)

Question 33

What types of treatments are there for MS?

Answer 33

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

Question 34

Which patients would be less suitable for Natalizumab?

Answer 34

High levels of JC Virus (risk of PML)

Question 35

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

Answer 35

Ocrelizumab

Question 36

What is the most efficacious MS treatment?

Answer 36

HCST (85%)

Question 37

What percentage of MS patients experience cognitive loss?

Answer 37

50% 25% is significant

Question 38

What are causes of neuropathic pain in MS?

Answer 38

Trigeminal neuralgia Limbs Hug Trucks

Question 39

What are aggravators of fatigue in MS patients?

Answer 39

Realised Exercise Heat Afternoon

Question 40

Who forms the MDT care in MS?

Answer 40

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

Question 41

What is the scale for disability in MS?

Answer 41

EDSS 1-10

Question 42

How does progression differ between progressive and relapsing remitting?

Answer 42

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

Question 43

How does pregnancy affect MS relapse rate?

Answer 43

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

Question 44

Why might statins be used for MS treatment?

Answer 44

Anti inflammatory Reduce risk of brain shrinkage in progressive disease

Question 45

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

Answer 45

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

Question 46

What is the rate of depression in MS?

Answer 46

50% at some stage 15% at any one time

Question 47

What antidepressants may be used for depression in MS?

Answer 47

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

Question 48

What is the typical type of cognitive loss in MS?

Answer 48

Subcortical Slowing, apathy, depression