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BB2 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

In MS patients, what is the typical history they present with that defines the condition?

A

Current neurological symptoms or a previous neurological episode, lasting at least 24 hours, without evidence of infection, fever, or encephalopathy.

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2
Q

What are the most common symptoms of MS? (3)

A

Sensory/motor problems (numbness, tingling, useless hand syndrome)
Vision loss, blurriness or diplopia
Slow progressive or sub-acute motor deficits

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3
Q

What symptoms do less than 5% of MS patients have at onset? (5)

A 
Bladder dysfunction
Heat intolerance
Pain
Movement disorders
Dementia
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4
Q

What are the 5 characteristic symptoms of demyelination?

A 
Optic neuritis or internuclear ophtalmoplegia
Lhermitte’s symptom
Uhthoff phenomenon
Paroxysmal symptoms
“Useless hand” (proprioceptive defect)
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5
Q

What type of condition is MS?

A

Chronic

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6
Q

What processes are involved in MS? (3 words)

A

Inflammation
Demyelination
Degeneration

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7
Q

What does an MRI detect on MS patients? (2)

A

Inflammatory demyelinating lesions

Brain atrophy

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8
Q

Lesions are disseminated in ____ and ____.

A

Space (two separate areas of the CNS)

Time (two different points in time)

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9
Q

What is gadoliniuim?

A

A contrast - used to enhance areas of inflammation

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10
Q

Lesions in what area are indicative of MS (because they are rare in other conditions)?

A

Corpus callosum

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11
Q

Why are lumbar punctures done in MS?

A

To test the CSF for oligoclonal bands (in health, should be positive in plasma and negative in CSF) and neurofilaments

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12
Q

What type of needle is now used for LPs?

A

Atraumatic

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13
Q

To diagnose MS, you need to… (4)

A

Exclude other causes
Find neurologic deficits
Dissemination in space
Dissemination in time

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14
Q

What diseases mimic MS? (8)

A 
Cerebrovascular disease
Syphilis
Lupus
Vasculitis
B12 def
Neuromyelitis optica
Sjogrens
Lyme's
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15
Q

How many people worldwide have MS?

A

About 2.5 million

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16
Q

How many people in the UK?

A

> 100 000 people

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17
Q

How many people are diagnosed each year?

A

5000 people

18
Q

MS is the most common cause of…?

A

Non-traumatic neurological disability

19
Q

By how many years is life expectancy reduced by in MS patients?

A

10-15 years

20
Q

Is MS genetic?

A

To some extent, but environment is more important.

21
Q

What causes preactive lesions? (5)

A 
Viral infections
Mitochondrial dysfunction
Anti-neuronal and anti-myelin antibodies
Reactive oxygen species
Neurodegeneration

These lead to neuronal, axonal and oligodendrocyte damage, as well as oligodendrocyte stress.

22
Q

What do oligodendrocytes do?

A

Make myelin

23
Q

Between which vertebrae do you go for LP?

A

L3 and L4

24
Q

What is seen in a pre-active lesion?

A

Microglia are activated and there is loss of myelin

25
Q

What is seen in an active lesion?

A

Macrophages are recruited that engulf myelin

26
Q

What is seen in a chronic active lesion?

What is seen in a chronic inactive lesion?

A

Macrophages at the lesion edge

Demyelination and axonal loss progression, then an astrocytic scar

27
Q

What comes first - CNS inflammation or neurodegeneration?

A

We don’t know! CNS inflammation could cause an immune response that causes neurodegeneration. Alternatively, neurodegeneration could cause an immune response that causes inflammation.

28
Q

What is the therapeutic hierarchy for MS? Start from the bottom.

A

Anti-inflammatory, neuroprotection, remyelination, neuro-restoration

29
Q

What symptoms require symptomatic treatment? (7)

A 
Neuropathic pain
Spasticity
Bladder and bowel dysfunction
Fatigue
Depression
UTIs
Tremors
30
Q

What can patients do to improve their condition?

A

Smoking cessation
Exercise
Diet
Sleep

31
Q

What are the methods of treatment? (7)

A 
Lymphocyte trafficking
Targeted immune regulation
Symptomatic treatment
Vaccine and tolerisation
Anti-proliferation agents
Interferons
Targeted mabs/fc-ab
32
Q

What are the two main pathways of treatment?

A

Maintenance-escalation and induction

33
Q

How many licensed induction therapies are there at present?

A

Only one

34
Q

What are the first line medications for escalation therapy?

A

Injectables: IFNb and GA
Orals: DMF and Teriflunomide
Natalizumab (highly active)

35
Q

What are the first line medications for induction therapy?

A

Alemtuzumab
Mitoxantrone
HSCT

36
Q

What are the second line medications?

A

Fingolimod
Natalizumab
Alemtuzumab
HSCT

37
Q

How is IFNb administered? How many times a week? What is the major side effect?

A

Sub-cut or IM
3 times
Flu-like symptoms

38
Q

How is GA administered? How many times a week?

A

GA
Sub-cut
Daily or 3 times

39
Q

How is teriflunomide administered? What are the two major risks?

A

Orally
Liver toxicity
Teratogenic

40
Q

How is natalizumab administered? How many times a month?

A

IV

Monthly

41
Q

How is fingolimob administered? What is the major risk?

A

Oral

Arrhythmia

42
Q

How often is alemtuzumab administered? What are the major side effects?

A

Yearly

Autoimmune thyroid disease and Goodpasture’s

BB2 (32 decks)

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