multiple sclerosis

Question 1

multiple sclerosis affects peripheral or central ns? UMN or LMN signs?

Answer 1

disorder of Central NS; UMN signs

Question 2

does MS affect gray or white matter more?

Answer 2

white matter predominantly

Question 3

what is the genetic factor of MS disease

Answer 3

HLA class II of chromosome 6: HLA-DRBI*1501 (strongest)

Question 4

Pathology of MS lesion’

what is the immunological resposne of MS lesion?

Answer 4

demyelination and axonal transection

activation of circulating CD4 cells specfici for myelin

Predominantenly T cell immune response. dysfunction in BBB allowing the actvated cells to cross into CNS attacking myelin

Question 5

what is the most common MS

Answer 5

relapsing-remitting MS

Question 6

what are the poor prognostic indicators

Answer 6

male** (men do worse than women even though it is more common in women)
older age at onset
posterior fossa symptoms at onset

African american (more aggressive agents for AA since its uncommon in AA) 
signficant residual disability from first attack

Question 7

what is present in almost all MS patients

Answer 7

Ebstein Barr Virus titers

Question 8

MS is common in what population?

Answer 8

women, caucasian, younger adults (18-55)

Question 9

what is the key dx for MS

Answer 9

Multiple sclerosis: need MULTIPLE scarring in the CNS

SEPARATED IN TIME AND SPACE***

Question 10

what is the most helpful diagnosis performed for MS

Answer 10

evoked potentials

Question 11

Neuromyelitis Optica devic vs MS

Answer 11

does not get white spots in brain, 100% B cell mediated disease , where as MS is mainly T cell (some B cells)

Question 12

what is the marker used to test for neuromyelitis Optica

Answer 12

Aquaporin-4ab (NMO-IgG): very specific, but less sensitive

Question 13

where are the lesions like MS vs NMO

Answer 13

MS isolated to C4-patchy lesions and NMO is longitutinally extensive spinal lesions

Question 14

which disease affects the pediatric population

Answer 14

Acute disseminated encephalomyelitis (ADEM)

Question 15

which disorder COMMONLY involves gray matter of CNS

Answer 15

ADEM

Question 16

if patient is confused, vision problem, and have SEIZURE*, what type of damage is this typically

Answer 16

Gray matter dysfunction–> can lead to acute disseminated encephalomyelits, because it is mainly involved with gray matter

Question 17

which disorder is mainly monophasic? (one time event)

Answer 17

ADEM

Question 18

what are the multiple sclerosis Tx

Answer 18

symptomatic tx, exacerbation tx(high dose steroids to shut down BBB), disease directed therapy

Question 19

what should be taken to impact the immune system for MS

Answer 19

Vitamin D

Question 20

which research focuses on axons to regenerate

Answer 20

nogo receptor

Question 21

which medication show improvement for gaiting

Answer 21

AMPRYA (4-aminopyridine)

Question 22

what is an important to test to help dx MS?

Answer 22

testing vision: optic disk edema* sign of MS

Question 23

what are unique findings on MRI for MS

Answer 23

corpus callosum has “spots” plaques