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Neuro > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the conventional/pathological definition of MS?

A

Inflammatory disease of the CNS characterised by demyelination and variable degrees of axonal loss and gliosis.

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2
Q

What is the clinical/pretheoretical definition of MS?

A

You need to have 2 episodes of inflammation/dysfunction in the CNS separated by time and place (ie 2 or more white matter structures), with no other aetiology

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3
Q

What is the typical MS pathology?

A

Perivenular inflammation

Demyelination

Gliosis: astrocytes which lead to fibrosis in brain

Variable axonal loss

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4
Q

How many people in the UK have MS?

A

120,000 (~50% are undiagnosed so there may be more)

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5
Q

When is MS onset?

A

20s-40s

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6
Q

What is the sex ratio like for MS?

A

Women are more likely to get it than men and then number of women getting it is increasing

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7
Q

Why is there an increasing MS incidence in women?

A 
Increase in fat consumption
Epstein-Barr virus
Smoking (accelerates MS)
Parity : fewer kids
Sunlight exposure (women using more sunscreen)
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8
Q

How does pregnancy affect MS?

A

The relapse rate drops during the 2nd and 3rd trimester and rebounds post-partum

This is probably due to pregnancy-induced immunosuppression

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9
Q

What is MS distribution like around the world and why?

A

There is less MS near the equator bc:

increased sunlight
possibly a virus

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10
Q

What is uhthoff’s phenomenon?

A

When it gets hotter, MS symptoms worsen

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11
Q

What proof is there that MS is related to environmental changes?

A

If you emigrate before 15 you take up the incidence of the place you moved to

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12
Q

Babies born in which month are more likely to get MS and why?

A

April (winter pregnancy) - reversed in southern hemisphere

Possibly bc mother gets less vitamin D

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13
Q

What proof is there that vit D is important in MS?

A

Danish newborn screening: Higher vitD had 50% chance less of MS

Finnish Maternal Vit D: Low vit D in early pregnancy x2 risk for kid

Monozygotic twins - lower vitD = higher MS risk
May also be related to be immobility

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14
Q

What amount of vit D is advised for MS?

A

5000 units/day

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15
Q

What is the contribution of genetics to MS?

A

Increased familial risk proportional to degree of relatedness

Many genes are affecting MS

Genetics support an immunological basis to the aetiology of MS

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16
Q

What are most genes affecting MS related to (hint: a protein)?

A

HLA

Others affect Vit D

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17
Q

What proof is there that the human microbiome has an affect in MS?

A

The EAE rodent model (injected with CNS tissue):

Germ free mice –> don’t get MS

With germs –> get MS

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18
Q

What are HERVS?

A

Human endogenous retroviruses

parts of our genomes that code for retroviruses

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19
Q

What role do HERVS have in MS?

A

Higher measure of HERV-W family envelope protein in MS

Found evidence of viral capsule in CNS in MS - areas of inflammation surrounding it

but antiviral vaccines have not helped MS

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20
Q

What are the courses of MS?

A

relapsing and then remitting

Primary-progressive: continue to worsen without remitting from the start

Secondary progressive: go from relapsing and remitting and go on to be progressive in 40-50s

Progressive-relapse

21
Q

Which is the most common course of MS?

A

relapsing remitting

22
Q

What is the connection between secondary and primary progressive

A

Probably the same thing except in primary the relapses were not noticed

23
Q

TRUE or FALSE?
If we do an MRI on an MS patient we see the same number of ‘bright spots’ on MRI as the number of relapses that patient has had.

A

FALSE

We see more bright spots

24
Q

What are the 3 main areas MS affects?

A

optic nerve
Brain stem
Spine

25
Q

What are the optic nerve symptoms of MS?

A

pain on eye movement

Losing the ability to distinguish colour

blurry central vision

26
Q

What are the spinal symptoms of MS?

A

Weakness
Numbness and tingling
Sphincter dysfunction

27
Q

What are the brain stem symptoms of MS?

A 
Double vision (diplopia)
Ataxia
28
Q

What are the miscellaneous symptoms of MS?

A 
Fatigue
Pain 
 Cognitive
Decline
Depression/anxiety
Spasticity
29
Q

What happens to MS patients’ employment over time?

A

Half of patients are unemployed within 10 yrs of diagnosis

30
Q

What score is used to tell how disabled a person is?

A

EDSS (0=good, 10= dead)

31
Q

Up to what EDSS scores are people with MS employable?

A

3 (up till this point they have no problems)

32
Q

What happens to an MS patient’s life span?

A

It decreases by 8-12 yrs

33
Q

What can we see on MS MRI scans?

A

T2 scan shows area of white (hyperintensitiy) - in white matter of ventricles

34
Q

How can we tell if a bright spot on an MRI is new?

A

Use gadolinium (shows where the BBB broke down recently by leaking through)

shows if BBB was affected in the last 6-8 weeks

35
Q

What tests do you give a suspected MS patient?

A

blood tests to check for inflammation
Visual evoked potential
MRI

36
Q

how do we treat acute relapses?

A

steroids - reduce the duration of relapses

37
Q

Why are steroids not so good to give patients?

A

They dont influence outcome

Can’t give them more than 2 times a year

side effects: avascular necrosis

38
Q

What happens in avascular necrosis and how do we treat it?

A

infarct of the femour head

needs hip replacement

39
Q

If an MS patient has sensory loss, weakness in both legs, and difficulty walking, what part of the CNS to we MRI?

A

cervical and thoracic areas

NOT brain bc then it would be asymmetrial

40
Q

What is natalizumab?

A

A MAb which prevents inflammatory cells from entering the brain through the BBB

41
Q

What are the side effects of natalizumab?

A

Pogressive multifocal leukal encephalopathy

42
Q

What causes PML?

A

JC virus causing progressive brain inflammation

43
Q

What increases risk of PML with natalizumab?

A

Previous immunosuppression

44
Q

What happens when you take someone with PML off of natalizumab?

A

Immune reconstitution: all immune cells go to brain (bad!)

45
Q

Name some disease modifying MS treatments

A 
Beta-interferon
Glatiramer
Teriflunomide
Dimethyl Fumerate
Alemtuzumab
46
Q

What effect does beta-interferon have on MS?

A

Slowed progression was shown
Halved symptoms and death
Very expensive (but worth it!)

47
Q

How do disease modifying MS treatments work?

A

reduce number of relapses –> slow progression

48
Q

What are the consequences of delaying MS treatment?

A

Relapses

Cerebral atrophy (shrinkage)

Earlier onset of progression

Dementia

Death

Neuro (23 decks)

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