multiple sclerosis

Question 1

what is ms

Answer 1

it sis a chronic autoimmune disease characterised by inflammation and damage to the myelin sheath
this the protective covering of the nerves in the cns

Question 2

what are the different types of ms

Answer 2

relapsing removing ms RRms ( 80% of diagnosis)
episodes of new or worsening symptoms known as exacerbations, followed by periods of partial or complete recovery which is known as remission - inflammation and demyelination occur during relapses - symptoms = weak, fatigue, sensory disturbance and visual problems

primary progressive ms PPms (10-15% of diagnosis)
gradual worsening of neurological functions overtime without distinct relapse or remission, inflammation and demyelination and axonal damage are more continuous, and there is no- distinct relapse compared to RRms. symptoms - leaking difficulties, stiffness and muscle weakness, bladder and bowel problems - usually after 15 years

secondary progressive ms SPms (50% of diagnosis)
this si the same as primary but it is juts more progressive

progressive relapsing ms PRms (rare)
steady progression of symptoms from the onset, with occasional relapse and exacerbation. symptoms - a gradual accumulation of disability and intermittent relapse with new or worsening symptoms that can lead to severe disability

Question 3

pharmacology - IMMUNOSUPPRESSANTS

Answer 3

immunosuppressants
MOA - they supress the immune system to reduce the inflammatory response against the myelin sheath . they target the specific immune t cells or b cells or inhibit the cytokines involved in the inflammatory cascade
side effects - flu like symptoms, injection site reaction, linear toxicity, increased risk of infection
examples - FINGOLIMOD, NATALIZAMAB, ALEMTUZCIMAB

NATALIZAMAB - for patients with rapidly developing rrMs
FINGOLIMED - only prescribed where patients have had beta interferon treatment for a year and still experience many relapses
ALEMUZUMAB- prescribed for active RRms and is as equally as effective as the other two.

Question 4

SPHINGOSINE -1 - PHOSPHATE RECEPTOR MODULATORS

Answer 4

MOA- they trap immune cells within lymph nodes preventing their migration into the cns reducing inflammation
side effects - bradycardia, muscular edema, liner enzyme elevation and increased risk of infection

example - fingolimed

Question 5

SELECTIVE ADHESION MOLECULE INHIBITORS

Answer 5

MOA - these drugs block the interaction between immune cells and endothelia cells preventing immune cell migration into the CNS
limitation - an example is NATALOZUMAB this is seen to increase the risk of PML, mostly inpatients with a previous exposure to the SC virus, close monitoring and risk of mitigation strategies are necessary to minise this risk

Question 6

demyelination in ms

Answer 6

demylination is the loss of saltatory conduction
the myelin sheath is used to insulate the axons for efficient transduction of action potential for nerve transmission
this demylination leads to impaired transduction of the action potential between nerve cells and therefore resulting in neurological symptoms

Question 7

diagnosis of ms

Answer 7

• there is demyelination plaques, adjacent to the cerebral ventricle in patients with ms
  this is seen through mri
  the white areas are the demyelinated areas

Question 8

what are the most common sites for demyelination in ms

Answer 8

• brain stem - vertigo
• cerebral cortex - intellectual impairment
• spinal cord - sensory loss, muscle weakness
• optic nerve - central loss of vision, double vision, optic nerve
• cerebellar tracts -

Question 9

what are the 3 categories of treatment plan

Answer 9

• reduce the relapse and induce remission ( early intervention) this when anti inflammatories are used ( short term treatment)
• limit and prevent new relapses (early) - immunotherapy is used (long term treatment)
• treatment of secondary and tertiary symptoms - antidepressants, stimulants and muscle relaxers