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Neuro > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

What is the autoimmune theory?

A

Autoimmune attack on the CNS
Inflammatory process leads to disruption of the BBB
Migration of antigen-specific T cells into CNS
Cascade of immunologic events
Demyelination

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2
Q

What are the RFs for MS?

A

Age
US citizen
Environment (virus/bacteria, smoking, vit D deficiency)
Genetics (HLA, MHC< IL2/7alpha)

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3
Q

What are primary sx of MS?

A

Direct consequence of demyelination

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4
Q

What are secondary sx of MS?

A

Complications secondary to primary sx

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5
Q

What are tertiary sx of MS?

A

Sx that relate to the effect of the disease on the patients everyday life

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6
Q

What are the ways to measure MS progression?

A

EDSS
MSFC
MRI

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7
Q

What are the 4 classifications of MS?

A

RRMS
SPMS
PPMS
PRMS

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8
Q

What does RRMS stand for?

A

Relapsing remitting MS

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9
Q

What is RRMS?

A

Clearly defined exacerbations

Acute worsening of neurologic function

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10
Q

What is the most common MS form at diagnosis?

A

RRMS

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11
Q

What is the most common form of MS?

A

RRMS

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12
Q

What does SPMS stand for?

A

Secondary progressive MS

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13
Q

What can SPMS develop from?

A

RRMS

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14
Q

What is SPMS?

A

Steadily worsening w/ or w/o occasional flare ups

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15
Q

What does PPMS stand for?

A

Primary progressive MS

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16
Q

What is PPMS?

A

Slow but continuous worsening of disease from onset
Worse prognosis
No distinct relapse or remission
Variations in rates of progression

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17
Q

What does PRMS stand for?

A

Progressive relapsing MS

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18
Q

What is PRMS?

A

Steadily worsening disease from onset
Clear, acute relapses w/ or w/o recovery
Periods between relapses continue disease progression

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19
Q

What are factors that may lead to an exacerbation?

A 
Infection
Heat
Sleep deprivation
Stress
Malnutrition
Anemia
Concurrent organ dysfunction
Exertion
Childbirth
20
Q

What is the first exacerbation known as?

A

Clinically isolated syndrome (CIS)

21
Q

How does MS affect mortality?

A

Does not directly decrease mortality

Increased mortality with secondary complications (pneumo, sepsis, decubitus ulcer, UTI)

22
Q

What rate is 7x the normal population for MS?

A

Suicide

23
Q

How is MS diagnosed?

A

2 episodes of neurologic disturbance
McDonald criteria
MRI
CSF (IgG)

24
Q

What are the treatment categories for MS?

A

Tx of acute attacks
Disease-modifying therapies
Symptomatic therapy

25
Q

What type of therapy are attack and disease-modifying therapies?

A

Immunotherapies

26
Q

What are the goals of immunotherapy in MS?

A

Decrease frequency and severity of exacerbations
Diminish the progression of lesions
Slow progression of disability

27
Q

What is the treatment of acute MS exacerbation?

A

HD IV methylprednisolone (500-1000) x 3-10d

28
Q

What are the disease-modifying therapies?

A 
Interferon beta
Glatiramer (Copaxone)
Natalizumab (Tysabri)
Mitoxantrone (Novantrone)
Fingolimod (Gilenya
Teriflunomide (Aubagio)
Dimethyl fumarate (Tecfidera)
Alemtuzumab (Lemtrada)
Ocrezlizumab (Ocrevus)
29
Q

What are the 2 interferon B1b?

A

Betaseron

Extavia

30
Q

What are the Interferon B1a?

A

Avonex
Rebif
Plegridy

31
Q

How does interferon work?

A

Suppresses T-helper cell response, reducing T cell migration across the BBB into the CNS

32
Q

What is the MOA of glatiramer?

A

Alteration of T cell activation and differentiation

33
Q

What is the MOA of mitoxantrone?

A

Decrease the migration of T cells into the CNS by arresting cell cycle

34
Q

What is the MOA of natalizumab?

A

Monoclonal antibodies of alpha4-integrin of the adhesion molecule VLA-4 on leukocytes. Inhibition of VLA-4 is responsible for blockade of T cells across the BBB

35
Q

What is the MOA of fingolimod?

A

Reduces the infiltration of T lymphocytes into the CNS

36
Q

What is the MOS of teriflunomide?

A

Inhibits pyrimidine synthesis thereby decreasing proliferation and inflammation

37
Q

What is the MOA of dimethyl fumarate?

A

Thought to be protextive against damage to the brain and spinal cord secondary to antioxidant properties brought about by activation of the Nrf2 pathway

38
Q

What is the MOA of alemtuzumab?

A

Monoclonal antibody directed at CD52, an antigen present on the surface of various types of immune cells
Results in depletion of circulating B and T lymphocytes

39
Q

What is first line in PPMS?

A

Ocrelizumab

40
Q

Which drugs are FDA approved for those with inadequate response or intolerance to other MS therapies?

A

Natalizumab
Alemtuzumab
Daclizumab

41
Q

What can be considered in worsening RRMS, SPMS, and PRMS whether or not relapses are occurring?

A

Mitoxantrone

42
Q

What are comorbidities with MS?

A 
Cognitive dysfunction
Depression
Fatigue
Paroxysmal sx
Spasticity
Sphincter dysfunction
Gait impairment
43
Q

How do we treat spasticity?

A

Baclofen

Tizanidine

44
Q

How do we treat bladder sx?

A

Tolterodine

Oxybutinin

45
Q

How do we treat sensory sx?

A

Gabapentin

46
Q

How do we treat fatigue?

A

Amantadine
Modafanil
Methylphenidate

47
Q

How do we treat gait impairment?

A

Dalfampridine

Neuro (13 decks)

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