multiple sclerosis

Question 1

Multiple sclerosis

Answer 1

an autoimmune disorder
a demyelinating disease, breaking down the myelin
more prevalent in women
chronic inflammatory disease of te central nervous system which leads to large focal lesions characterized by demyelination

Question 2

risk factors

Answer 2

• vitamin D deficiency
• obesity early in life
• cigarette smoking
• associated to specific infections
• genetics; through sequencing the genome

Question 3

diagnostic hallmark

Answer 3

presence of large confluent demyelinated lesions in white and grey matter

Question 4

dysmyelinating disease / leukodystrophy

Answer 4

myelin is not properly formed or has abnormal turnover kinetics.
Most mutations involved in formation of myelin.

Question 5

demyelinating disease

Answer 5

damage to the normal myelin
MS is the most common

Question 6

myelin plasticity

Answer 6

determines the size/strong of the signal
- de novo myelination of unmyelinated axon segment
- retraction or replacement of existing segments
- thickening or thinning of existing myelin sheets
- lengthening or shortening of existing myelin sheets

Question 7

pathogenesis

Answer 7

1. acute phase; inflammation
2. loss of myeline and oligodendrocytes
3. reactive proliferation and hypertrophy of glial cells
4. development of multifocal lesions (plaques)
5. loss of neurons

Question 8

plaques

Answer 8

inactive plaques; inflammation has disappeared
active plaques; abundant macrophages and t-cells, active inflammatory process

Question 9

symptoms

Answer 9

fatigue, muscle spams, tingling, disturbed balance, difficulty walking, numbness.
the symptoms depend on the place of the lesions.

Question 10

early stage

Answer 10

immune cell infiltration, breach of the BBB
increased inflammatory response, myeline will be damaged.

Question 11

late stage

Answer 11

lower infiltration of peripheral immune cells
chronic intrinsic inflammation and suppress damage repair

Question 12

diagnosis

Answer 12

• McDonald criteria
• medical history
• neurological exam; functional
• evoked potential tests; brain response
• lumbar puncture; to see what the spinal fluid contains
• MRI; more white is accumulation of lipid
• differential diagnoses

Question 13

McDonald criteria

Answer 13

evidence of damage to the central nervous system that is disseminated in time and space.showing that damage has occurred at different dates and to different parts of the central nervous system

Question 14

second stage

Answer 14

progressive-relapsing MS
symptoms gradually become worse, but distinction between attacks and remission
can progress into secondary progressive MS

Question 14

first stage

Answer 14

clinically isolated syndrome
relapsing-remitting MS
pain comes in attacks

Question 15

severe

Answer 15

primary progressive MS
experience symptoms constant, without recovery

Question 16

disease modifying drugs

Answer 16

do not treat symptoms
do not reverse damage
counteract autoimmunity
decreases new nerve damage and clinical attacks

Question 17

IFN-B

Answer 17

first line treatment
decrease in quantity of cell-associated adhesion molecules; inhibition of MHC-2 expression
inhibiting antigen presentation

Question 18

dimethyl fumarate

Answer 18

induces NRF-2 > induction of antioxidant and anti-inflammatory genes

Question 19

anti-CD20 antibodies

Answer 19

will neutralize CD20, B cells will not mature

Question 20

natalizumab

Answer 20

inhibition of interaction between proteins in cellular immune cells within ICAM-1 and VCAM-1.
antibody will block the integrin A4, decreased leucocyte infiltration into the CNS