Multiple sclerosis Flashcards
What is MS?
Autoimmune inflammatory disease that attacks myelinated axons in the CNS
What are the common symptoms of MS?
Sensory/motor:
- numbness/tingling in arms + legs
- electric current sensation dow back/legs
- useless hand syndrome
Vision:
- blurred vision
- vision loss
- diplopia
Which symptoms are less commonly associated with the onset of MS?
- bladder dysfunction
- heat intolerance (heat causes nerves to conduct less efficiently)
- pain, movement disorders
- dementia
What characteristics of MS are detected on MRI?
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
Why is a lumbar puncture taken in MS?
Compares components of CSF to plasma (e.g. presence of blood cells, lymphocytes)
Measures neurofilaments: if high = indicative of ongoing nerve loss
What are the diagnostic criteria for MS?
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
What are the different types of MS?
- relapsing-remitting = attack will occur but will go back to baseline (most common type - 75-90%)
- secondary progressive = if R-R s not treated the condition will become progressive
- primary progressive = pt never relapses + progressively gets worse
- Progressive-relapsing = between relapses (attacks of symptoms) the disease will continue to get worse
progressing subclinically = NEDA
What are the potential causes of MS?
Viral infection of neurones
Mitochondrial dysfunction
Release of heat shock
What are the stages of forming a chronic active/chronic inactive MS lesion?
**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
What drug is commonly given during an “MS attack”?
High dose prednisolone (steroid) - reduce inflammation
What are the 2 strategies of treatment?
- Maintenance-escalation: drugs that are not super effective but won’t have many side effects
- Induction: very aggressive anti-inflammatory drugs with serious side effects
What are the first line and second line DMTs in MS?
First line:
- Escalation = injectables (IFNb + GA), natalizumab
- Induction = alemtuzumab, mitoxantrone, HSCT
Second line:
- fingolimod
- natalizumab
- HSCT