Multiple Sclerosis

Question 1

hey are cells in the peripheral nervous system (PNS) that produce the myelin sheath around neuronal axons.

Answer 1

schwann (neurilemma) cells

Question 2

They are cells in the central nervous system (CNS) that produce the myelin sheath around neuronal axons

Answer 2

oligodendrocytes

Question 3

• acquired conditions characterized by preferential damage to previously normal myelin.
• commonly result from immune-mediated injury.
• drugs and other toxic agents.

Answer 3

Demyelinating diseases

*Once normal myelin, then it’s damaged

Question 4

• myelin is not formed properly or has abnormal turnover kinetics.
• associated with mutations affecting the proteins required for formation of normal myelin or in mutations that affect the synthesis or degradation of myelin lipids.
• the other general term for these diseases is leukodystrophy.

Answer 4

Dysmyelinating diseases

*The myelin itself is abnormal (Genetic/familial)

Question 5

multiple sclerosis (MS) is an autoimmune demyelinating disorder characterized by (1), separated in time, attributable to (2) that are separated in space

Answer 5

1. neurologic deficits
2. white matter lesions

Question 6

MS is common (demyelinating/dysmyelinating) disorder

Answer 6

demyelinating

Question 7

MS is predominantly a disease of young adults with a mean age of onset around ()

Answer 7

30 years old (15-45 years old)

Question 8

types of MS

Answer 8

1. relapsing remitting (RR-MS)
2. primary progessive (PP-MS)
3. relapsing progressive (RP-MS)
4. secondary progressive (SP-MS)

Question 9

type of MS wherein:
* there is clinical exacerbation of neurological symptoms, followed by periods during which the person fully or partially recovers from the acquired neurological deficits.
* Most common (80% of MS patients)

Answer 9

relapsing remitting (RR-MS)

Question 10

type of MS wherein:
* Gradual progression of the disease from onset, no overlapping relapse or remission.
* 10-20% of cases.

Answer 10

primary progessive (PP-MS)

Question 11

type of MS wherein:
* Initially presents as PP-MS
* During the course of the disease, individuals develop true neurologic deficit exacerbations.
* Steady progression of clinical neurological damage with superimposed relapses and remissions.

Answer 11

Relapsing progressive (RP-MS)

Question 12

type of MS wherein:
* Steady progression of neurological damage with or without superimposed relapses and minor remissions.
* Patients will have experienced a period of RR-MS before which may have lasted 2-40 years.
* Relapses and remissions fade over time.
* 50% of RR-MS will eventually develop this.

Answer 12

Secondary progressive (SP-MS)

Question 13

list some risk factors for ALS

Answer 13

1. genetics (sex, family history, race, polymorphism)
2. environmental (infections, Vit. D deficiency, smoking, obesity)

Question 14

• A clinical attack is considered if the symptoms are present for at least (1) and is preceded by more than (2) of clinical stability.

Answer 14

1. 24 hours
2. 30 days

Question 15

when determining if patient has clinical attack of MS, we must first rule out ()

Answer 15

psuedorelapse

Examples of psuedorelapse: metabolic stress, infections that worsens the symptoms. or if the symptoms last for LESS than 24 hours. (in a relapse the symptoms have to occur for MORE than 24 hours.)

Question 16

Clinical exacerbation of neurological symptoms

Answer 16

relapse

Question 17

person fully or partially recovers from the acquired neurological deficits

Answer 17

remission

Question 18

some common patterns of neurological symptoms in MS

Answer 18

1. unilateral visual impairment
2. spinal cord lesions

Question 19

Unilateral visual impairment occurring over the course of a few days is frequent initial manifestation of MS due to involvement of the ()

Answer 19

optic nerve “ optic neuritis “

Question 20

() give rise to motor and sensory impairment of trunk and limbs, spasticity, and difficulties with the voluntary control of bladder function .

Answer 20

spinal cord lesions

Question 21

In any individual patient MS is hard to predict when the next relapse will occur ; most current treatments aid to () rather than recovering lost function .

Answer 21

decrease the rate and severity of relapses

Question 22

The pathologic hallmark of MSis multiple focal areas of ()

Answer 22

myelin loss within the CNS (plaques or lesions).

Question 23

MS selectively affects (white/gray) matter of CNS

Answer 23

white

Question 24

Classical location of plaques are at the periventricular regions of the (1), (2), and the (3).

Answer 24

1. brain
2. optic nerves
3. spinal cord

Question 25

() occurring in early MS lesions contribute to the relapse related disability observed predominantly during the disease’s inflammatory phase

Answer 25

Acute axonal injury

Question 26

() will cause axonal loss or sclerosis resulting in permanent deficits.d

Answer 26

Chronic axonal injury

Question 27

which immune cells are involved in the neuroinflammation associated with MS

Answer 27

(CD8+) cytotoxic T-lymphocytes, (CD4+) T-lymphocytes and B cells

Question 28

Why don’t we classify MS as an autoimmune disease?

Answer 28

Direct proof of an autoimmune response is lacking, no specific autoantibody or autoreactive T cells

Question 29

• Mc Donald’s MS diagnostic criteria (2017)
  : Diagnosis of “Clinically definite MS” needs demonstration of ()

Answer 29

dissemination of space and time.

Question 30

Indications for treatment of a relapse include (1) symptoms with objective evidence of (2).

Answer 30

1. functionally disabling
2. neurologic impairment

Question 31

what is the main idea behind experimental autoimmune encephalomyelitis (EAE)

Answer 31

researchers inject the animals with proteins that are normally found in the myelin sheath. These proteins trick the animal’s immune system into thinking these proteins are dangerous, causing it to attack the myelin, similar to what happens in MS.