Question 1

Multiple sclerosis (MS)

Accepted Answer

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. Characterized by perivascular inflammation and demyelination. 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.

Question 2

Multiple sclerosis (MS) epidemiology

Accepted Answer

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 8x more likely to develop the disease. 30% concordance rate in identical twins. Female to male (2.5:1) - men more likely to have greater disability/cognitive impairment (w/ less evidence of inflammation on MRI). Onset of MS in women is about 5 years earlier than men.

Question 3

Diagnostic criteria for multiple sclerosis (MS)

Accepted Answer

MS remains more or less a diagnosis of exclusion given symptom heterogeneity. Generally requires: 1) must have two or2 2) more objective clinical attacks with positive MRI findings (CNS lesions) Dissemination of lesions in space can be in at least one T2 lesion in 2 of 4 areas: periventricular, juxtacortical, infratenotial, and/or spinal cord New MRI lesion may establish dissemination in time regardless of time from baseline.

Question 4

Common clinical symptoms multiple sclerosis (MS)

Accepted Answer

- Optic Neuritis - Inflammation of the optic nerve results in blurring of vision (unilateral) - paresthesias (i.e., sensation of numbness and tingling), accounts for about 21 to 55% - Corticospinal tract symptoms include bladder and bowel dysfunction; accounts for about 32 to 41% - 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 (about 80% adults, 50% of children) - sleep disturbance, can also be secondary to pain and spasticity in MS; maybe due to lesions that disrupt sleep-wake cycles or inflammatory processes, pain/discomfort, bowel/bladder issues, anxiety and worrying about the disease

Question 5

Disease categories/courses in Multiple sclerosis

Accepted Answer

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.

Question 6

Multiple sclerosis neurocognitive outcomes

Accepted Answer

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 Thought that verbal memory and EF --> Most predictive of vocational disability Pediatric: In addition to above outcomes, children tend to have more language difficulties

Question 7

What is the most frequent and disabling symptom commonly reported by patients with multiple sclerosis?

Accepted Answer

Fatigue

Question 8

What findings might you see in laboratory results considering the diagnosis of multiple sclerosis?

Accepted Answer

low levels of vitamin D and elevated forms of cytokines (immune system) vitamin D regulates immune response by decreasing production of pro-inflammatory cytokines.

Question 9

Describe longitudinal neuropsychological outcomes in pediatric MS

Accepted Answer

there is no clear expected longitudinal pattern

Question 10

Pregnant women with multiple sclerosis often experience

Accepted Answer

fewer relapses. After giving birth, there may be a resurgence in relapses.

Question 11

Concordance rate of MS among identical twins

Accepted Answer

25%

Question 12

In patients with MS, depressive disorders have a lifetime prevalence of about

Accepted Answer

50%

Question 13

The prevalence rates of cognitive symptoms among adult patients with MS is approximately

Accepted Answer

~50%

Question 14

In terms of treatment of cognitive dysfunction in MS, the best support appears to be for

Accepted Answer

Amphetamines (as this improves attention deficits)

Question 15

Demyelinating lesions in MS are most likely to occur in the

Accepted Answer

Brainstem (also: optic nerves, periventricular white matter, corpus callosum, cerebellum, and spinal cord white matter)

Question 16

Factors associated with increased risk for MS.

Accepted Answer

Genetic predisposition exposure to cigarette smoke living at latitudes farther from the equator

Question 17

Environmental factors of MS

Accepted Answer

Pediatric MS --> increased frequency of Epstein Barr virus, with other pathogens including spirochetal bacterial infections, varicella zoster, and chlamydophila pneumoniae. Cigarette smoking may increase risk in adults and secondhand in children Breastfed babies are less likely to develop MS. Lower vitamin D levels.

Question 18

Determinants of Severity for MS

Accepted Answer

Ranges form benign MS to debilitating. younger age = lower relapse rate, slower rate of progression. Racial/ethnic minorities are less likely to contract MS. Lower levels of vitamin D levels. Pregnant women tend to experience fewer relapses, may even see improvement in function ---> possibly due to hormonal factors.

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Multiple Sclerosis Flashcards

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