Multiple Sclerosis Flashcards

1
Q

What is MS?

A

Autoimmune inflammatory disease which attacks myelinated axons in the CNS

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2
Q

How is MS diagnosed?

A

Neurological symptoms/previous neurologic episode lasting 24 hours
- no evidence of infection/fever/encephalopathy

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3
Q

What are the most common symptoms of MS?

A
  • sensory/motor (tingling/numbness of arms and legs, electric current sensation down back/legs)
  • vision problems (blurriness/loss/diplopia)
  • slow progressive/subacute motor deficits
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4
Q

What are more rarer symptoms? (less than 5% patients experience)

A
  • bladder dysfunction (frequency, incomplete emptying)
  • heat intolerance (heat causes nerves to conduct less efficiently)
  • paroxysmal symptoms
  • pain movement disorders
  • dementia
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5
Q

What are the 3 main characteristics of an MRI on MS?

A
  • Flair lesion spread out in space (in more than 2 CNS areas, lesion in corpus callosum/periventricular/spinal cord)
  • Flair lesion occurring at different points in time (development of new lesion after seeing old one)
  • Brain atrophy
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6
Q

What is the significance of a lumbar puncture for MS?

A
  • safe if sterile
  • atraumatic needle (no damage to dura)
  • compares components of CSF to plasma (blood cells, lymphocytes)
  • measures neurofilaments
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7
Q

What is the significance of neurofilament amount?

A
  • high = indicates ongoing nerve loss

- protein component of axons

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8
Q

What are the diagnostic criteria of MS?

A
  • dissemination in space (symptoms in more than 1 place in CNS)
  • dissemination in time (chronic condition)
  • rule out all other diagnoses
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9
Q

What are the types of MS?

A
  • relapsing-remitting (attack occurs then goes back to baselines)
  • secondary-progressive (relapse-remitting is not treated so condition becomes progressive)
  • primary progressive (patient never relapses and progressively gets worse)
  • progressive-relapsing (between relapses disease will get worse)
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10
Q

What are relapses?

A

Attacks of symptoms

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11
Q

What is the genetic component of MS?

A
  • associated with HLA-DRB1*1501

- not very relevant as offspring chances are relatively low

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12
Q

What are the causes of MS?

A

relatively unknown:

  • viral infection of neurons
  • mitochondrial dysfunction
  • release of heat shock
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13
Q

What is the pathology of MS?

A
  • axons still present but no myelin around them
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14
Q

Which cells are involved in MS?

A
  • neurons
  • astrocytes
  • oligodendrocytes
  • microglia
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15
Q

What are the 4 types of lesions?

A
  • pre-active lesion (activated microglia and myelin loss)
  • active lesion (lymphocyte infiltration around vessels)
  • chronic active lesion (lymphocyte spread out around lesion, macrophages engulf myelin and sit on lesion edge)
  • chronic inactive lesion (remyelination attempt however already significant enough demyelination and axon loss = astrocytic scar)
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16
Q

How does an astrocytic scar present?

A

Black hole on MRI/shadow plaque

17
Q

What is the cycle of neuron MS damage?

A

Immune response -> CNS inflammation -> neurodegeneration

CNS inflammation = immune response so cycle, positive feedback

18
Q

What treatment should be given during an attack?

A
  • prednisolone

- high dose, earlier treatment the better

19
Q

What are the 2 strategies of treatment?

A
  • maintenance escalation (not super aggressive drugs, not many side effects)
  • induction (very aggressive anti-inflammatory drugs with serious side effects)
20
Q

What are some first line disease modifying drugs?

A
  • escalation (injectables - IFNb, natalizumab)

- induction (alemtuzumab, mitoxantro, HSCT)

21
Q

What are some second line disease modifying drugs?

A

Natalizumab
HSCT - haematopoietic stem cell transplantation
Fingolimod