Multiple Sclerosis Flashcards
Pathological basis MS
Demyelination
Inflammation and degeneration
Pathogenesis
- Immune cell activation (ie cross reactivity with EBV)
- Environmental factors: Vitamin D deficiency, smoking
- Genetic; HLA gene
- Other: glutamate, free radicals, hypoxia
Epidemiology MS
Young white people (less than 30, northern hemispheres, females)
Clinically isolated syndrome
First attack
MRI may already have lesions
Relapsing Remitting
Attacks with near- recovery separating them. Distinct in time and space. Eventually will turn into progressive
Primary progressive
Ongoing increasing disability, without acute attack phase
May see asymmetric weakness (ie foot drop)
Secondary Progressive
Ongoing increasing disability, without attacks
Optic Neuritis
Epi: affects 50% of people in first 5 years
Fx: vision loss over hours to days, eye pain, afferent pupillary defect, loss of colour vision
Ddx: lupus, sarcoid, MS, paraneoplastic, anterior ischemic optic neuropathy
Uthoff’s Phenomemn
Recurrence of MS symptoms with heat or fatigue
Lhermitte’s Sign
Electric shock sensation down back with bending of neck- part of transverse myelitis presentation
Investigations MS
MRI + GAD
- shows Dawson’s fingers: periventricular lesions
- juxtacortical, infratentorial, corpus callosum
Internuclear opthalmaplegia
Decreased adduction of one eye due to lesion at MLF (eyes become ‘unyoked’)
Treatment targets in MS
- The ok activation in periphery
- T cell adhesion
- T cell reactivation
Teriflunomide
Oral agent, decreased peripheral activation by decreasing proliferation of b and T cell s
Contra: do not give if pregnant
Alemtuzumab
Infusion of monoclonal antibodies
Prevents peripheral activation
May cause ITP, goodpasture syndrome
