Multiple sclerosis Flashcards

1
Q

What is MS?

A

Autoimmune inflammatory disease that attacks myelinated axons in the CNS

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2
Q

What are the common symptoms of MS?

A

Sensory/motor:

  • numbness/tingling in arms + legs
  • electric current sensation dow back/legs
  • useless hand syndrome

Vision:

  • blurred vision
  • vision loss
  • diplopia
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3
Q

Which symptoms are less commonly associated with the onset of MS?

A
  • bladder dysfunction
  • heat intolerance (heat causes nerves to conduct less efficiently)
  • pain, movement disorders
  • dementia
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4
Q

What characteristics of MS are detected on MRI?

A

T2/Flair lesion shows dissemination in space (>2 CNS areas): periventricular, supratentorial, spinal cord, cerebellum, also corpus callosum

T2/Flair lesion shows dissemination in time - development of one new lesion after seeing an old one

Brain atrophy

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5
Q

Why is a lumbar puncture taken in MS?

A

Compares components of CSF to plasma (e.g. presence of blood cells, lymphocytes)
Measures neurofilaments: if high = indicative of ongoing nerve loss

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6
Q

What are the diagnostic criteria for MS?

A

Neurological symptoms needs to occur in >1 place int eh CNS (brain, spinal cord, optic nerve = dissemination in space)
Needs to be a chronic condition = dissemination in time
Must rule out all other possible diagnoses

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7
Q

What are the different types of MS?

A
  1. relapsing-remitting = attack will occur but will go back to baseline (most common type - 75-90%)
  2. secondary progressive = if R-R s not treated the condition will become progressive
  3. primary progressive = pt never relapses + progressively gets worse
  4. Progressive-relapsing = between relapses (attacks of symptoms) the disease will continue to get worse

progressing subclinically = NEDA

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8
Q

What are the potential causes of MS?

A

Viral infection of neurones
Mitochondrial dysfunction
Release of heat shock

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9
Q

What are the stages of forming a chronic active/chronic inactive MS lesion?

A

**it is a demyelinating disease
Cells involved: neurones; astrocytes; oligodendrocytes’ microglia
Pre-active lesion = activated microglia and loss of myelin
Active lesion = lymphocyte infiltration around the blood vessels

Chronic active lesion = lymphocytes spread out around lesion
- macrophages engulf myelin and sit on the lesion edge

Chronic inactive lesion = attempt at remyelination
- will form an astrocytic scar

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10
Q

What drug is commonly given during an “MS attack”?

A

High dose prednisolone (steroid) - reduce inflammation

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11
Q

What are the 2 strategies of treatment?

A
  1. Maintenance-escalation: drugs that are not super effective but won’t have many side effects
  2. Induction: very aggressive anti-inflammatory drugs with serious side effects
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12
Q

What are the first line and second line DMTs in MS?

A

First line:

  • Escalation = injectables (IFNb + GA), natalizumab
  • Induction = alemtuzumab, mitoxantrone, HSCT

Second line:

  • fingolimod
  • natalizumab
  • HSCT
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