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PM3B: Spring > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is a multiple sclerosis?

A

A neurodegenerative autoimmune conditions that strikes the central nervous system

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2
Q

What are the symptoms of Multiple sclerosis and what is it characterised by?

A

Weakness
Numbness
Loss of sense- taste and sight
Loss of balance

Multiple episodes of the same or different neurological symptoms separated by periods of remission- relapse and remitting

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3
Q

What is multiple sclerosis in terms of primary progressive?

A

Start of disease

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4
Q

What is multiple sclerosis in terms of secondary progressive?

A

Relapsing and remitting form of MS

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5
Q

How do you diagnose multiple sclerosis and describe each one?

A
  1. Combination of time course for clinical episodes
  2. Lesions detected by MRI: able to see white matter
  3. CSF markers
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6
Q

What is detected in progressive MS?

A

Detection of oligoclonal bands- these are immunoglobulins not found in CNS

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7
Q

What is the biological basis of multiple sclerosis

A
  1. Inflammation in the brain and spinal cord
  2. Loss myelin sheaths: demyelination
  3. Axonal damage and neuronal loss
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8
Q

What are the consequences of multiple sclerosis

A
  1. Acute loss of function
  2. Chronic damage
  3. Repairable damage
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9
Q

Describe inflammation in multiple sclerosis

A
  1. Immune cells infiltrate CNS and attack cells within the brain and spinal cord involved in myelination- infiltrate consists of lymphocytes and macrophages
  2. Autoimmune response: body targets own cells
  3. Active MS plaques also contain myelin whorls, proteins and lipids
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10
Q

What is the myelin sheath formed by and what is it made of to assist in

A
  1. Oligodendrocytes in the CNS

2. Sheath: Lipid 70% and Protein 30% insulation to help the electrochemical transmission of action potentials

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11
Q

What does a damaged myelin sheath lead to

A

Ability of nerve cells to transmit action potential

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12
Q

When does remyelination occur and does it work

A
  1. Early stages of MS: rapid and extensive remyelination
  2. Complete remyelination of lesions can occur
  3. Commonly fails
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13
Q

In neurodegeneration, how many axons are lost in the chronic lesions

A

Loss of 68%

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14
Q

Describe conduction block in relapse where symptoms get worse

A

Demyelination and increase in inflammation

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15
Q

Describe restoration of conduction in remission

A

Remylination and decrease in inflammation

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16
Q

Uhtoff’s is described as a positive phenomena, what is it?

A
  1. Worsening of neurological conditions when the body gets overheated from hot weather, exercise etc
  2. Leads to nerves getting blocked
17
Q

Lhermitte’s is described as a positive phenomena, what is it?

A

An electrical sensation that runs down the spine and into the limbs- generally uncomfortable

18
Q

What are the environmental concerns of MS

A
  1. Epstein Barr virus: Evidence of increased infection during early adulthood
  2. Decreased sunlight exposure or low vitamin D are contributing factors
19
Q

What are the genetic concerns of MS

A
  1. Increased risk linked to close family members developing disease
  2. Major histocompatibility locus
  3. Genome wide association study identified with further immune related genes
20
Q

What is stoppable in MS

A

Inflammation in the brain and spinal cord

21
Q

What is repairable in MS

A

Loss of myelin sheaths- demyelination

22
Q

What is irreparable but preventable in MS

A

Axonal damage and neuronal loss

23
Q

What are the treatment episodes in acute relapse?

A
  1. High dose: corticosteroid
  2. Oral methylpredinisolone: 500mg
  3. IV methylprednisolone: 1g
24
Q

What is the monoclonal antibody to use in rapidly evolving severe relapsing MS and its mechanism

A
  1. Natalizumab-Tysabri
  2. Inhibits leucocyte migration into CNS, binds to a4 subunit of a4b1, a4b7 intergrins, expressed on surface of activated T cells
  3. Prevents binding of cells to receptors on endothelium
25
Q

Describe the mechanism of action of Fingolimod (Gileyna)

A
  1. Sequesters lymphocytes in lymph nodes: prevents them from crossing blood brain barrier
  2. Reduces relapse
  3. Possible treat: highly active relapsing remitting MS
26
Q

What is the role of alemtiuzumab?

A

Anti-CD20 antibody: reducing anti-inflammatory response in MS early

27
Q

What is the Teriflunomide?

A
  1. ONCE daily oral immunomodulator
  2. Inhibition of dihydro-orotate dehydrogenase
  3. This is necessary for rapidly dividing lymphocytes
28
Q

What is the first line management of spasticity and spasms in MS

A

Baclofen: GabaB receptor agonist, inhibition of spinal reflexes

GABAPENTIN: Ca channel blockers

29
Q

What is the second line management of spasticity and spasms in MS

A

Tizanidine (Alpha 2 agonist,muscle relaxant)

Diazepam and Clonazepam: Benzodiazepines, GABAa agonists

Dantrolene, Intrathecal Baclofen

Sativex

30
Q

What mediation is used for retention and urgency/incontinence

A

Retention: Alfuzosin

Urgency and incontinence: Trospium and Flavoxate

31
Q

What drugs do you use for fatigue, emotionalism, depression, anxiety and walking

A
  1. Fatigue: Modafinil
  2. Emotionalism: TCA or SSRI
  3. Depression: standard treatment
  4. Walking: Famipridrine
32
Q

What can cannabinoids be used MS patients

A
  1. Many MS patients self medicate by smoking cannabis
  2. Ameliorate:
    Tremor and spascity
    Pain
    Bladder Function

PM3B: Spring (21 decks)

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