Multiple Sclerosis

Question 1

Immune-mediated disease of the CNS that is associated with inflammation, demyelination, axonal loss/neurodegeneration/atrophy in both white and grey matter

Answer 1

Multiple Sclerosis

Question 2

Most common cause of non-traumatic disability in young adults

Answer 2

MS

Question 3

There is a higher incidence of MS in

Answer 3

Women

Question 4

EBV infection, vitamin D insufficiency, smoking tobacco, and obesity are all environmental risk factors for

Answer 4

MS

Question 5

In a brain with MS, we see

Answer 5

White matter plaques

Question 6

Induces conduction blocks in structurally intact axons, drives demyelination, and induces transection of axons (with consequent conduction block) within acute lesions

Answer 6

Lymphocyte-driven inflammation

Question 7

Activated microglial cells might contribute to the repair mechanisms that lead to

Answer 7

Remyelination or to the degeneration of axons

Question 8

Redistribution of sodium channels along demyelinated axons could restore

Answer 8

Conduction

Question 9

Astrocytic activation and proliferation (gliosis) might impede

Answer 9

Repair

Question 10

Focal disturbances of function >24 hours

–Occur on average once a year in untreated patients

Answer 10

MS Relapse

Question 11

MS relapses occur in the absence of

Answer 11

Environmental, metabolic, or infectious processes

Question 12

At least one objective clinical episode with neurological symptoms lasting for 24 hours or longer (with no symptomatic infection)* is required for diagnosis of

Answer 12

Relapsing-Remitting MS (RRMS)

Question 13

We also need dissemination in time and space to diagnose with

Answer 13

RRMS

Question 14

One year of disease progression is needed to diagnose with

Answer 14

Primary-Progressive MS (PPMS)

Question 15

We use blood tests to exclude MS mimics such as

Answer 15

Lyme Disease or B12 Deficiency

Question 16

What is an infectious disease that mimics MS?

Answer 16

Lyme Disease

Question 17

What are four inflammatory diseases that mimic MS?

Answer 17

SLE, Sarcoidosis, Neuromyelitis, and ADEM

Question 18

Cervical or thoracic spondylosis also mimics

Answer 18

MS

Question 19

Often a monophasic demyelinating disease

-May be induced by viruses or vaccination

Answer 19

ADEM

Question 20

The most common tick-transmitted disease in the northern hemisphere

-Caused by spirochetes of the Borrelia burgdorferi species complex

Answer 20

Lyme Disease

Question 21

Frequently indistinguishable from MS on both clinical and radiologic grounds. Patients may have focal neurologic deficits, relapsing–remitting disease

Answer 21

Lyme Disease

Question 22

Brain WM abnormalities with MS-like features are found in approximately

Answer 22

75% of lyme patients

Question 23

Characterized by a specific IgG antibody marker (NMO antibody)

Answer 23

Neuromyelitis Optica Spectrum Disorders (NOSD)

Question 24

The target antigen in NMOSD is a water channel abundant in the CNS called

Answer 24

Aquaporin-4

Question 25

Characterized by inflammatory demyelination in the CNS, for example in the optic nerves and spinal cord

Answer 25

NMOSD

Question 26

What is used to treat acute MS relapses?

Answer 26

High dose IV steroids or ACTH

Question 27

What is a common high-dose IV steroid used to treat acute MS relapse?

Answer 27

Methylprednisone

Question 28

2nd generation fumaric acid ester used as a disease modifying treatment for MS

Answer 28

BG 12

Question 29

Monoclonal antibody blocking adhesion of VLA-4 positive T cells to VCAM-1 positive endothelial cells

-used as SMT

Answer 29

Natalizumab

Question 30

S1P receptor agonist used as DMT

Answer 30

Fingolimod

Question 31

Monoclonal antibody targeting and deleting CD20 positive B cells

-Used as DMT

Answer 31

Ocrelizumab

Question 32

Increases risk of infections and malignancies

Answer 32

Ocrelizumab

Question 33

Has been shown to cause PML in 0.3% of treated patients

Answer 33

Natalizumab

Question 34

What are two DMTs for secondary progressive MS (SPMS) and Primary Progressive MS (PPMS)

Answer 34

Mitoxantrone and Ocrelizumab

Question 35

Has been approved by FDA for SPMS but is not commonly used due to potential serious adverse effects

Answer 35

Mitoxantrone

Question 36

Approved for PPMS in 2017

Answer 36

Ocrelizumab