Multiple Sclerosis Flashcards
MS- Epidemiology
More common in N. European descent
age of onset is normally between 20 and 50
W>M- 70%
normal presentation is caucasian female in the appropriate age range
MS- etiology
10x greater risk if pt has a 1st degree relative with the dz
High prevalence in identical twins
HLA-DR2 mutation
Thought to be environmental or viral infection trigger.
MS- pathophysiology
Autoimmune demyelinating dz
Th1>Th2
Cytokines: IFN gamma, TNF alpha, and IL-12 recruit macrophages to demylenate neruons (destroy Myelin basic protein)
There are also Anti Myelin Abs from B cells
MS- areas effected by demyelination
Optic nerve periventricular white matter brain stem cerebellum spinal cord
MS- predominant signs and symptoms
Dz is random and has various progressions- common symptoms are
Optic nerve- Optic neuritis is common 1st presenting symptom
Cerebellar involvement- ataxia, scanning speech
Spinal tract involvement- weakness, parasthesias, urinary incontinence
Pontine demyelination of the MLF –> blurry vision, normally bilateral= internuclear opthalmoplegia
Lab findings- MS
CSF findings correlate to the pathological process
inc protein (Myelin basic protein and gamma globulins), inc lymphocytes, normal glucose
oligoclonal gammaglobulin bands
Radiologic Findings- MS
white matter looks like gray matter due to demyelination
may have no clinical findings but see lesions on MRI
Multiple lesions in space and time
MS- Dx
spinal tap
MRI with contrast
MS- acute tx
during attack use IV high dose methylprednisone
MS chornic tx
Glatiramer
IFN beta
Natalizumab (mAb)
cytotoxic agents- cyclophosphamide, methotrexate, azathioprine
MS- prognosis
4 possible Relapsing and remitting- best Secondary progressive- starts as R/R by having attacks with partial recoveries, but each results in permanent disability Primary progressive- starts progressive Progressive- Relapsing- worst
