Multiple Sclerosis Flashcards
Multiple sclerosis (MS)
chronic, progressive inflammatory autoimmune disorder of the central nervous system (CNS)
the immune system response results in an attack on myelin sheathing in the brain and spinal cord, resulting in axonal damage and slowing axonal signal transmission.
Though previously considered a disease of the white matter only, it is now well established that gray matter can also be involved, even in the earliest stages.
Multiple sclerosis (MS) epidemiology
primarily affects young adults between the ages of 20 and 40 (average age of onset about 30)
Pediatric MS:
2% to 5% onset prior to the age of 18, <1% have onset pre-puberty
First degree relatives of patients with MS are 6 to 8 times more likely to develop the disease
Female to male (2.5:1) - men more likely to have greater disability/cognitive impairment
Diagnostic criteria for multiple sclerosis (MS)
MS remains more or less a diagnosis of exclusion given symptom heterogeneity
Generally requires: the patient must have two or more objective clinical attacks with positive MRI findings (CNS lesions)
Common clinical symptoms multiple sclerosis (MS)
- Optic Neuritis - Inflammation of the optic nerve results in blurring of vision (unilateral)
- paresthesias (i.e., sensation of numbness and tingling)
- Corticospinal tract symptoms include bladder and bowel dysfunction
- Symptoms of cerebellar and brainstem lesions may include ataxia, speech problems (e.g., dysarthria), or diplopia (i.e., double vision)
- Fatigue, often exacerbated by heat
- sleep disturbance, can also be secondary to pain and spasticity in MS
Disease categories/courses in Multiple sclerosis
Relapsing –Remitting (85%):
- most common initial diagnosis
- Periods of stability and improvement between episodes
Secondary—Progressive:
- Initially presents as RRMS but is followed by progressive worsening relative to baseline functioning between attacks with no periods of remission.
Primary—Progressive (10%):
- Continuous gradual worsening of functions from the onset with minor fluctuations, but no distinct exacerbations or periods of remission.
- symptoms: muscle stiffness or weakness
- least common presentation
Progressive—Relapsing (5%):
- Progressive deterioration of function from the onset but punctuated by distinct acute exacerbations/relapses.
Multiple sclerosis neurocognitive outcomes
Most common:
Processing speed (d/t corpus callosum thinning)
sustained attention/concentration
learning and declarative memory impairments
deficits tend to progress over time d/t whole brain (specifically thalamic) atrophy
Depression, anxiety, and emotional lability are common
Pediatric: in addition to above outcomes, children tend to have more language difficulties
What is the most frequent and disabling symptom commonly reported by patients with multiple sclerosis?
Fatigue
What findings might you see in laboratory results considering the diagnosis of multiple sclerosis?
low levels of vitamin D and elevated forms of cytokines (immune system)
vitamin D regulates immune response by decreasing production of pro-inflammatory cytokines.
Describe longitudinal neuropsychological outcomes in pediatric MS
there is no clear expected longitudinal pattern
Pregnant women with multiple sclerosis often experience
fewer relapses. After giving birth, there may be a resurgence in relapses.
Concordance rate of MS among identical twins
25%
In patients with MS, depressive disorders have a lifetime prevalence of about
50%
The prevalence rates of cognitive symptoms among adult patients with MS is approximately
~50%
In terms of treatment of cognitive dysfunction in MS, the best support appears to be for
amphetamines (as this improves attention deficits)
Demyelinating lesions in MS are most likely to occur in the
Brainstem
(also: optic nerves, periventricular white matter, corpus callosum, cerebellum, and spinal cord white matter)
