Multiple Sclerosis

Question 1

MS

Answer 1

• Acquired
• Inflammatory – causes destruction of the myelin
• Demyelinating
• Disease of the CNS
  Antibodies against the myelin produced by oligonucleotides

Question 2

Age of onset

Answer 2

20-50 years

Question 3

how many affected world wide ??

Answer 3

2.5 million affected worldwide

Question 4

Where is MS more prevalent ?

Answer 4

Mainly in cold countries - more prevalent the further away from the equator

Question 5

Phases of MS

Answer 5

Disease starts before symptoms
Initiation – 5-20 years
Latent phase 10-50 years - Asymptomatic lesions
Disease onset – 20-50 years
Remitting relapsing phase – episodes of demyelination < when diagnosed
Progressive phase -Steady progression

Question 6

Genetic Factors

Answer 6

Vitamin D

Viral infection

Question 7

what is significant about women in pregnancy in relation to MS?

Answer 7

Woman pregnant in winter months are more likely to have children with MS

Question 8

Pathogenesis

Answer 8

Antibodies against X antigen and cross reacts with myelin – in contact with antigen produces AB and starts to kill myelin
Not a brain infection – more like flu

Question 9

B- Lymphocytes

Answer 9

• APC
• Memory
• Precursor of plasma cells – produce auto Abs
• Reg inflammatory response

Question 10

immunological difference in CNS compared to PNS

Answer 10

• Do not induce an immune response
• Due to BBB
• Glial end foot and tight junction with mitochondria close it off

Question 11

In MS what is breached ??

Answer 11

Blood Brain barrier -Adhesion molecules in capillaries interact with the immune activated cells
Activation of macrophage’s and microglia in CNS
Dysfunction of Oligonucleotides
Inflammation in Peripheral but effect in the central

Question 12

Effect on axons

Answer 12

• Myelin stripped off – impulse don’t jump from node of ranvier to the next
• K+ channels prevent Leak back
• Conduction block produced – LOSS OF SIGNAL

Question 13

Clinical Presentations

Answer 13

• Gait – ambulation > longest distance between leg and head – pass a long segment of CNS – need loads of neurons to walk properly
• Foot drop – delay in impulse transmission > plastic splint/ stimulate nerves in leg switch in patients shoes

Question 14

Dalfampridine

Answer 14

blocker of K channels helps impulse to move across axon faster
- Only works for 35% of MS patients

Question 15

What is spasticity ?

Answer 15

Legs become weak and stiff- stiffness is

Question 16

• Reflex arc

Answer 16

anterior horn cells within spinal cord controlled by cells in motor cortex normally anterior horn is quiet
-Anterior horn cells fire in response to everything and causes stiffness > Spasticity

Question 17

The Bladder in MS

Answer 17

smooth muscle
- Complex organ
- External ureter sphincter – skeletal muscle/ Chronically active
- Bladder itself is smooth muscle
- Spinal cord cause bladder to contract > urination requires sphincter to relax
- Co-ordination between smooth and skeletal muscle – done by maturation centre in Pons- smooth contract skeletal relaxes
- Control for when you want to – frontal lobe trained to do it
Bladder issues – can cause urine to go back into kidneys
- Incontinence

Question 18

Treatment of Bladder issues in MS

Answer 18

• Block parasympathetic nerves –
• Block NMJ
• Stimulate sympathetic
• Artificial sphincter

Question 19

Symptoms of MS

Answer 19

Varies from brain to bladder

-Brain > Cognition and speech

Question 20

MS Relapse

Answer 20

• Acute lasting longer than 24 hours

- 2 weeks > month

Question 21

MS Progression

Answer 21

• Gradual decline of symptom’s

Question 22

Types of MS

Answer 22

1. Progressive- Relapsing
2. Secondary- Progressive
3. Primary -Progressive
4. Relapsing – Remitting

Question 23

Diagnosis

Answer 23

Dissemination in time and Dissemination in space

• MRI
• CSF – Lumbar puncture
• Evoked response
• 2 out of 4 sites affected

Question 24

MRI

Answer 24

white patches Demyelination

• T2 W Hyper intense lesions
• Dye with Gad – shown in Blood vessels

Question 25

Lumbar puncture

Answer 25

• Look for oligo pronal bands (look at) in CSF in MS

- Demonstrates inflammation isolated to the CNS

Question 26

Hemapoetic Stem cell transplant-

Answer 26

eliminating aberrant immune memory using chemo
- Stem cell – undifferentiated and no immune memory
- Then give SC back
Problems
- Mortalilty higher
- Optomisation of protocols