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NBB1 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

How do we define multiple sclerosis?

A

Immune mediated disease of CNS, associated with:

  • Inflammation
  • demyelination
  • axonal loss/neurodegernation
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2
Q

What is the etiology of MS?

A

Unknown, but potentially autoimmune or viral

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3
Q

Is there a test for MS?

A

No, a clinical diagnosis

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4
Q

What are the genetic risk factors for MS?

A

Female gender

HLA-DR2 allele

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5
Q

What are the environmental risk factors for MS?

A

EBV infection
Vitamin D insufficency
Smoking
Obesity

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6
Q

What is the pathology of MS

A

White matter plaques

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7
Q

What is complexity of MS?

A

Unsure if inflammation or neurodegeneration

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8
Q

What is targeted in MS pathogenesis?

A

oligodendrocytes

white AND gray matter

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9
Q

How can we track MS symptoms?

A

According to brain regions that are affected

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10
Q

What are the KEY symptoms of MS?

A

Optic neuritis
Intranuclear ophthalmoplegia
Myelitis
Trigeminal neuralgia

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11
Q

What are the 3 types of MS, and which is most common?

A 
Relapsing/remitting --> secondary progressive 
Primary progressive (10%)
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12
Q

What are the principles of RRMS diagnosis? (3)

A
  • At least 1 objective clinical episode w/ neuro symptoms for 24 hours or longer
  • Dissemination in time and in space
  • Exclusion of common mimic disorders (clinical history, MRI, lab tests)
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13
Q

What laboratory tests are used for look for MS?

A

MRI
Blood tests: eliminate lyme, B12 deficiency
CSF: for PPMS
Evoked potential: not included now

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14
Q

What findings do we see in a CSF sample? (2) Is this diagnostic?

A

NO

  • Elevated IgG index
  • Oligoclonal bands
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15
Q

What are common diseases that mimic MS?

A 
Lyme
SLE
Sarcoidosis
Neuromyelitis optica
ADEM
B12 deficiency
Cervical/thoracic spondylosis
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16
Q

What is neuromyelitis optica?

A

inflammatory demyelination of optic nerves and spinal cord

17
Q

What is neuromyelitis optica characterized by?

A

specific IgG antibody marker: NMO antibody

18
Q

What is the target antigen of neuromyelitis optica?

A

aquaporin-4, a water channel abundant in the CNS

19
Q

What is neuroborreliosis, and how does it mimic MS?

A
  • NB produces focal neurological deficits, relapsing, remitting disease
  • MS-like features found in 75% of patients with neuroborreliosis with focal symptoms - often indistinguishable!
20
Q

How is CNS lupus confused with MS?

A
  • CNS lupus presents with multiple types of white matter lesions on brain MRI, demyelinating lesions in brainstem, optic nerve and spinal cord
  • Associated with many neurological symptoms
21
Q

What similar features do MS and B12 deficiency have?

A
  • Neurological symptoms and lesions

- Linked to occasional multiple focal and confluent white matter hyperintensities on brain MRI

22
Q

What often causes B12 deficiency?

A

pernicious anemia - autoimmune disorder attacking IF

23
Q

What is ADEM?

A

Acute disseminated encephalomyelitis

24
Q

How does ADEM mimic MS?

A

Often monophasic demyelinating disease, very difficult to differentiate from 1st MS attack

25
Q

What do we use to treat acute clinical phase of ADEM?

A

IV steroids

26
Q

What are the goals of MS management?

A 
Treating relapses
Decreasing frequency of relapses
Delaying progression to disability
Managing MS-associated symptoms
Facilitating an acceptable quality of life
27
Q

How do we define an MS relapse?

A

focal disturbances of function: > 24h

In absence of environmental, metabolic, infectious processes

28
Q

How does natalizumab work?

A

Humanized monoclonal antibody

29
Q

How does teriflunomide work?

A

reversibly inhibits mitochondrial enzyme for pyrimidine synthesis

30
Q

How does Fingolimod work?

A

s1p receptor agonist

31
Q

What are some common side effects of DMTs?

A

hair loss, PML, decreased HR

32
Q

What is the treatment for secondary progressive MS? Why is it not used very often?

A

Mitoxantrone, serious side effects

33
Q

What is used most often for fatigue?

A

amantidine, modafinil

34
Q

What is used to improve walking speed?

A

dalfampridine

35
Q

What is used for bladder dysfunction?

A

ditropan, botox

36
Q

What is used for spasticity?

A

Baclofen

37
Q

What is used for pain and sensory symptoms?

A

anti-depressants, anti-epileptics

38
Q

What is used for depression?

A

Psychotherapy, anti-depressants

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