Multiple Sclerosis Flashcards
What is the basic physiologic problem that causes Multiple Sclerosis?
An autoimmune, inflammatory, and chronic progressive disease that causes demyelination and neuronal loss in the brain and spinal cord.
Myelin = coating on the neurons that helps speed up electrical transmission through nerves
What change occurs with demyelination of the neuron?
- In a normal neuron, electrical conduction flows continuously through the neuron
- Myelin speeds up transmission by helping the electricity skip along the axon
- Demyelination causes it to go skip → through → skip → through
- There are going to be distorted and delayed messages which leads to loss of function in the body
What are the three pathologic processes associated with MS?
- Chronic inflammation
- Demyelination
- Gliosis
What is Gliosis?
- Gliosis is proliferation and hypertrophy of glial brain cells in response to inflammation
- Glial cells are the supporting cells in the CNS
What are the three different types of MS?
- Relapsing–Remitting (RRMS)
- Secondary Progressive (SPMS)
- Primary Progressive (PPMS)
Describe Relapsing–Remitting (RRMS).
Individuals experience flare-ups of symptoms called “relapses” followed by periods of partial or complete recovery known as “remissions.“
Describe Secondary Progressive (SPMS).
Symptoms gradually worsen over time after an initial phase of relapsing-remitting MS (RRMS).
Primary Progressive (PPMS)
Symptoms gradually worsen without remissions.
What are the typical initial manifestations associated with MS?
- Vision problems (caused by optic neuritis)
- Sensory impairment (paresthesia)
- Paresthesia is an abnormal feeling of tingling, burning, pricking, numbness, itching, or skin crawling that occurs without an outside cause.
What are the clinical manifestations associated with MS?
Areas commonly affected by MS:
- Optic nerve (visual field)
- Cerebellar (speech and swallowing)
- Corticospinal tracts (muscle strength/weakness and spasticity)
- Spinocerebellar tracts (balance)
- Posterior cell columns of the spinal cord (position and vibratory sensation)
- Psychological manifestations “head stuff” (depression, memory loss)
things are lost or slowed down
Most common non-specific manifestation of MS?
Fatigue
Why are corticosteroids used to treat/manage MS?
Usually given for acute relapses to quickly decrease inflammation.
anti-inflammatory & immunosuppressant
What are two primary non-pharmacologic interventions to address MS?
- Good nutrition
- A high-fiber diet is recommended for people with MS who experience constipation
- Adequate rest and relaxation
- Stress may precipitate an exacerbation of the disease
Medications used to treat MS?
- Vumerity
- Kesimpta
- Lemtrada
- Ocrevus
Vumerity intended action?
Used for relapsing forms of MS
No alcohol ingestion at the same time med is taken
Vumerity side effects?
- Angioedema
- Hepatotoxicity
- Flushing
- GI distress
- Decreased WBC
- PML (progressive multifocal leukoencephalopathy) - Rare brain infection
Kesimpta intended action?
Used for relapsing-remitting MS
Kesimpta side effects?
- Increased risk for infection (specifically respiratory infections)
- Headache
- PML
- Can reactivate Hepatitis B
- No live vaccines!
Lemtrada intended action?
- Immunosuppressant used to treat relapsing forms of multiple sclerosis (MS)
- Used for patients with highly active disease, even after trying at least two other disease-modifying therapies (DMTs)
Lemtrada side effects?
- Increased risk for infection
- Thrombocytopenia
- Hypo or Hyperthyroidism
- Nephrotoxicity
- Insomnia
Ocrevus intended action?
Only approved drug for Primary Progressive MS
Ocrevus side effects?
- Respiratory tract infections
- Reactivated viral infections (Hepatitis, Herpes)
- PML
- Immunosuppression
