multiple sclerosis Flashcards

1
Q

Multiple sclerosis

A

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

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2
Q

risk factors

A
  • vitamin D deficiency
  • obesity early in life
  • cigarette smoking
  • associated to specific infections
  • genetics; through sequencing the genome
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3
Q

diagnostic hallmark

A

presence of large confluent demyelinated lesions in white and grey matter

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4
Q

dysmyelinating disease / leukodystrophy

A

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

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5
Q

demyelinating disease

A

damage to the normal myelin
MS is the most common

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6
Q

myelin plasticity

A

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

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7
Q

pathogenesis

A
  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
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8
Q

plaques

A

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

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9
Q

symptoms

A

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

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10
Q

early stage

A

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

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11
Q

late stage

A

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

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12
Q

diagnosis

A
  • 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
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13
Q

McDonald criteria

A

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

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14
Q

second stage

A

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

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14
Q

first stage

A

clinically isolated syndrome
relapsing-remitting MS
pain comes in attacks

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15
Q

severe

A

primary progressive MS
experience symptoms constant, without recovery

16
Q

disease modifying drugs

A

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

17
Q

IFN-B

A

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

18
Q

dimethyl fumarate

A

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

19
Q

anti-CD20 antibodies

A

will neutralize CD20, B cells will not mature

20
Q

natalizumab

A

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