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Neuroscience > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Which type of matter is affected in MS

A

Both gray and white matter
The classic definition stated it was an inflammatory demyelinating disease of white matter however there is clear evidence that this is cortical gray matter involvement as well. GM damage is related to WM damage

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2
Q

classic definition of MS

A

MS is characterized by recurrent attacks of multi focal sites where multiple episodes are separated by at least 30 days and occur at different sites within the CNS

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3
Q

female to male ratio

A

2 to 1 but some sources say 4 to 1

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4
Q

Geographic distribution

A

less incidence in more tropical zones; greater occurrence in temperature zones and Syracuse. This may be a Vitamin D related issue or some kind of virus that can get killed in hotter climates

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5
Q

onset age range of MS

A

20-50 with peak incidence in late 20s to early 30s (average is 32)

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6
Q

most common race for MS

A

Caucasians of northern European decent

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7
Q

Three possible factors for cause of MS

A

genetics
environmental trigger
immune dysfuction

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8
Q

explain the environmental trigger factor

A

o Found more in temperature zones
 Virus can survive in these areas but not in warmer climates
o Lack of Vitamin D during childhood

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9
Q

explain the immune dysfunction factor

A

o Detected during exacerbations
o Some have T cell abnormalities
o Symptoms of MS typically worsen during viral infections

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10
Q

White Matter Pathology

A

There is an inflammatory response of myelin in the CNS. This may be due to a problem with the blood brain barrier that accounts for lesions.

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11
Q

Gray Matter Pathology

A

Less is known about exact pathological processes occurring in GM damage
Some lesions extend from the pia through the first 3 layers of cell bodies in the cortex
Evidence shows that axonal damage can occur. If the cell body dies, the axon will degenerate
Could also be due to a retrograde signal that leads to damage of the cell body

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12
Q

What contributes to the severity of symptoms

A

the degree of swelling following breakdown of myelin

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13
Q

Why may gray matter involvement increase as the disease progresses?

A

This is because re-myelinzation becomes less effective

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14
Q

What do the specific symptoms of MS depend on?

A

Depend on WHERE myelin and gray matter is attacked

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15
Q

Where is white matter damage more common?

A

More common white matter damage is in the optic nerve, cerebellum, SC, brainstem then cerebral cortex

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16
Q

How quickly can symptoms develop in MS?

A

Can develop over hours or several days or even weeks
Most commonly 6-15 hours
Some symptoms are more continuous such as fatigue and depression

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17
Q

List the most common symptoms of MS

A 
•	FATIGUE
•	DEPRESSION
•	Focal muscle weakness
•	Ocular disturbance
o	Nystagmus  (cerebellar lesion)
o	Double/blurry vision
•	Urinary and bowel disturbance
•	Gait ataxia (cerebellar lesion)
•	Spasticity/babinski (UMN lesion)
•	Parasthesias/anesthesias (somatosensory path lesion)
•	Dysmetria/intention tremor/ataxia (cerebellar lesion)
•	Neuropathic pain
•	Heat intolerance
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18
Q

Less common, but not uncommon symptoms

A
  • Dysarthria
  • Scanning speech
  • Facial palsy (UMN lesion)
  • Vertigo
  • Cognitive dysfunction
  • Short-term memory
  • Conceptual reasoning
  • Problem solving and multi-tasking issues
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19
Q

Rarer symptoms

A
  • Decreased hearing
  • Dysphagia
  • Seizure
  • Tinnitus
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20
Q

what causes ocular disturabances

A

CN II is myelinated by oligodendrocytes resulting in vulnerability to MS whereas all other CN are myelinated by Schwann cells

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21
Q

What are paraclinical signs?

A

pertaining to abnormalities (e.g., morphological or biochemical) underlying clinical manifestations (e.g., chest pain or fever).

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22
Q

the 3 paraclinical signs associated with MS

A

UWOs
VEP
Lumbar Puncture

23
Q

What are UWOs

A

unidentified white objects found on the MRI
o One can have totally benign spots
o May have symptoms before any white spots develop
o Very specific criteria for white spots

24
Q

What are VEPs

A

visual evoked potentials
o Slowed conduction of optic nerve
o Also have somatosensory evoked potentials (SSEP) and brainstem auditory evoked potentials (BAEP)

25
Q

Reason for lumbar puncture

A

o See what’s floating in the CSF
o “myelin basic proteins” are present during an acute attack
 This is a reason to give corticosteroids

26
Q

what are the 2 ways to diagnose definitive MS

A
  • 2 attacks more than 30 days apart with clinical evidence of 2 separate lesions
  • 2 attacks with clinical evidence of 1 lesion and paraclinical evidence of separate lesion (abnormal MRI, abnormal evoked potentials or abnormal CSF)
27
Q

What is clinical isolated syndrome?

A

an initial neurological episode or attack that lasts at least 24 hours and can be monofocal or multifocal
• One “event” that may “look” like an MS event
• Some with CIS will switch to MS

28
Q

What do those who convert to MS show?

A

They tend to show GM involvement

29
Q

Having what on the MRI makes people wtih CIS 63% more likely to be diagnosed with MS

A

having white spots on the MRI makes them more likely to end up being diagnosed with MS

30
Q

Describe Benign MS

A 
relapsing remitting but NO progressions
has relapse but goes back to baseline
fully functional 15 years after diagnosis
little to no disability
20-25%
31
Q

describe relapsing-remitting

A

most common
clearly defined exacerbation and remissions that can last from days to months
residual deficits but can have recovery from exacerbations

32
Q

describe progressive relapsing

A

least common
exacerbations and remissions
continued disease progression between exacerbations

33
Q

describe Secondary progressive

A

o Occurs in 90% of those with relapsing-remitting(RR)
o Starts at RR then suddenly becomes primary progressive
o Geometric worsening of baseline at any point; usually have warning signs
o 14 fold increase in GM involvement
o Most common we will see at PTs

34
Q

describe primary progressive

A

o Sometimes called unrelenting MS
o 10-15%
o Do not respond to conventional treatments
o Worse case
o Have a problem with oligodendrocytes and perhaps significant GM involvement
o Tend to be older when diagnosed

35
Q

Factors that contribute to a favorable diagnosis

A
  • Low relapse rate
  • Long interval between first and second relapse
  • Complete recovery from first relapse
  • Younger age at onset
  • Female
  • Low disability and 2 years and 5 years post diagnosis
36
Q

factors that contribute to an unfavorable diagnosis

A
  • High exacerbation rate in first 5 years, short time between 2st and 2nd attack
  • Cerebellar, sphincter or cognitive symptoms early
  • > age than 40 at onset
  • Lower brainstem involvement (CN IX, X, XII)
37
Q

factors that contribute to patients psychological status relating to MS

A 
•	Difficulty getting diagnosed
o	Often misdiagnosed initially
o	“somatoform conversion disorder”
	Converting psychological to physical
•	Unpredictable course
•	Covert symptoms
o	Fatigue, depression, bladder, vision
38
Q

the 2 broad goals of treatment

A

control relapses and symptom managment

39
Q

List ways to control relapses

A

anti-inflammatory corticosteroids
decrease frequency of exacerbations with immune modulators
immunosuppressants

40
Q

what is the top choice for coriticosteriods to control relapses

A

IV prednisone

41
Q

For which clinical course are immunosuppressants used

A

used in “unrelenting” MS

blocks Tcell attack in the brain

42
Q

What symptoms do we try to manage?

A 
depression
fatigue/lassitude
heat intolerance
stiffness/spasticity
bladder dysfunction
bowel dysfunction
pain
mobility
tremors
emotional lability
seizures
43
Q

How do we determine appropriate dosage for Baclofen?

A
  1. Way to find the right dose is gradually increase

2. It is too much when you get marked weakness “dishrag feeling”

44
Q

What can happen with sudden stoppage of Baclofen

A

seizures and hallucinatons

45
Q

What is the primary drug for stiffness/spasticity

A

Baclofen

“artificial GABA”

46
Q

Why is Bacolfen a great drug?

A

minimal side effects (weakness, letarghy, GI issues) that don’t last long because they have a short 1/2 life so they go away quickly

47
Q

What does the dosing start at for Baclofen?

A

starts at 5 mg/ day, 3x a day

48
Q

What is the depression rate for MS

A

60%

medications such as tricyclics are used

49
Q

define lassitude

A

“hit the wall” feeling

different from muscle fatigue

50
Q

what makes up primary fatigue

A

both motor fatigue and lassitude

it is the most encompassing symptom

51
Q

what is secondary fatigue

A

the body’s response to the disease

a result of MS symptoms and trying to compensate for them

52
Q

What does Amprya do?

A

used for motor fatigue and can increase conduction of AP

53
Q

What does Provigil?

A

an anti-narcoleptic that is effective for lassitude

Neuroscience (14 decks)

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