Multiple Sclerosis Flashcards
Immune-mediated disease of the CNS that is associated with inflammation, demyelination, axonal loss/neurodegeneration/atrophy in both white and grey matter
Multiple Sclerosis
Most common cause of non-traumatic disability in young adults
MS
There is a higher incidence of MS in
Women
EBV infection, vitamin D insufficiency, smoking tobacco, and obesity are all environmental risk factors for
MS
In a brain with MS, we see
White matter plaques
Induces conduction blocks in structurally intact axons, drives demyelination, and induces transection of axons (with consequent conduction block) within acute lesions
Lymphocyte-driven inflammation
Activated microglial cells might contribute to the repair mechanisms that lead to
Remyelination or to the degeneration of axons
Redistribution of sodium channels along demyelinated axons could restore
Conduction
Astrocytic activation and proliferation (gliosis) might impede
Repair
Focal disturbances of function >24 hours
–Occur on average once a year in untreated patients
MS Relapse
MS relapses occur in the absence of
Environmental, metabolic, or infectious processes
At least one objective clinical episode with neurological symptoms lasting for 24 hours or longer (with no symptomatic infection)* is required for diagnosis of
Relapsing-Remitting MS (RRMS)
We also need dissemination in time and space to diagnose with
RRMS
One year of disease progression is needed to diagnose with
Primary-Progressive MS (PPMS)
We use blood tests to exclude MS mimics such as
Lyme Disease or B12 Deficiency
What is an infectious disease that mimics MS?
Lyme Disease
What are four inflammatory diseases that mimic MS?
SLE, Sarcoidosis, Neuromyelitis, and ADEM
Cervical or thoracic spondylosis also mimics
MS
Often a monophasic demyelinating disease
-May be induced by viruses or vaccination
ADEM
The most common tick-transmitted disease in the northern hemisphere
-Caused by spirochetes of the Borrelia burgdorferi species complex
Lyme Disease
Frequently indistinguishable from MS on both clinical and radiologic grounds. Patients may have focal neurologic deficits, relapsing–remitting disease
Lyme Disease
Brain WM abnormalities with MS-like features are found in approximately
75% of lyme patients
Characterized by a specific IgG antibody marker (NMO antibody)
Neuromyelitis Optica Spectrum Disorders (NOSD)
The target antigen in NMOSD is a water channel abundant in the CNS called
Aquaporin-4
Characterized by inflammatory demyelination in the CNS, for example in the optic nerves and spinal cord
NMOSD
What is used to treat acute MS relapses?
High dose IV steroids or ACTH
What is a common high-dose IV steroid used to treat acute MS relapse?
Methylprednisone
2nd generation fumaric acid ester used as a disease modifying treatment for MS
BG 12
Monoclonal antibody blocking adhesion of VLA-4 positive T cells to VCAM-1 positive endothelial cells
-used as SMT
Natalizumab
S1P receptor agonist used as DMT
Fingolimod
Monoclonal antibody targeting and deleting CD20 positive B cells
-Used as DMT
Ocrelizumab
Increases risk of infections and malignancies
Ocrelizumab
Has been shown to cause PML in 0.3% of treated patients
Natalizumab
What are two DMTs for secondary progressive MS (SPMS) and Primary Progressive MS (PPMS)
Mitoxantrone and Ocrelizumab
Has been approved by FDA for SPMS but is not commonly used due to potential serious adverse effects
Mitoxantrone
Approved for PPMS in 2017
Ocrelizumab
