Multiple sclerosis Flashcards
1
Q
What is MS
A
- Chronic autoimmune disease
- Progressive disease
- Involves immune system and neurological system
- Multifocal areas of demyelination- presenting symptoms will depend on which neurones in which part of the brain in affected
- Disrupts ability of the nerve to conduct electrical impulses
- Leads to symptoms
2
Q
Epidemiology of MS
A
- First described in 1868 by Jean-martin Charcot
- Age onset 20-50 years old
- Women are twice as likely to develop MS
- Between 100-140 cases per 100,000 people
- 1800-3400 people in England and Wales
- Over 2.5 million world wide
- More prevalent in Caucasians
3
Q
Etiology of MS
A
- Genetic: MS is polygenic (not just one gene), MS susceptibility genes. MS associated genes, which may influence the overall clinical course of MS
- Vit D3
- Infection e.g. virus, EBV, chlamydia
- Environmental facots
4
Q
Role of vitD in MS
A
- US cohort study found that 3.5 times more women residing in northern states were diagnosed with MS than southern states
- The incidence of MS highest in North Temporal Climate
- MS more prominent in areas reporting less than 2000 hours of sunshine annually
- MS displays seasonable variability with increased activity in the Spring and lowest in. the Autumn.
- A Finnish study found in MS patients lower serum vitamin D levels in the Spring.
- A link between dietary intake of vitamin D and the incidence of MS has been suggested in Norway along the coastal areas where fatty fish, dairy products, and cereals are all rich in vitamin D consumed in higher amounts. The incidence is lower than the rest of Norway.
- Dietary information from the Nurses Health Study of 187,000 women showed those with a history of vitamin D supplementation as low as 400 units daily had a 40% less chance of developing MS
5
Q
Nerve condition in healthy myelinated cells in the CNS
A
- Healthy
6
Q
Speed of Ap in axons
A
- Unmyelinated axon conducted: 0.5 to 10 m/s
- Myelinated axon conducted up to 150 m/s
7
Q
Symptoms
generic symptoms shows why diagnosis can take a long time
A
- Vision disturbances
- Numbness
- Difficulty walking/ Co-ordination/ Balance problems
- Fatigue
- Depression/Emtionalchanges
- Vertigo and dizziness
- Spasticity
- Sexual dysfunction
- Pain
- Change in cognitive function
- Bowel/bladder dysfunction
8
Q
Lhermitte sign
A
- Lhermitte’s sign or Lhermitte’s syndrome is a sudden sensation resembling an electric shock that passes down the back of the neck and into the spinal column and can radiate out to the fingers and toes
- It is usually triggered by flexing the neck, that is, bending your head down, chin towards chest and is sometimes referred to as barber’s chair syndrome
- Lhermitte’s sign is rarely treated as the pain is so sharp and sudden that it does not usually last long enough for pain treatments to take effect
9
Q
Uhtoffs sign
A
- Uhthoff’s phenomenon or Uhthoff’s sign is the temporary worsening of symptoms, most often visual symptoms but sometimes motor or sensory - caused by an increase in temperature
- The visual symptoms may present as double vision, sharpness of vision, or black spots in the eyes
- The symptom takes its name from Wilhelm Uhthoff, a German neuro-opthamologist, who first described it in 1890
10
Q
Clinical presentations in MS
A
- Loss or reduction of vision in 1 eye with painful eye movements
- Double vision
- Ascending sensory disturbance and or weakness
- Problems with balance, unsteadiness or clumsiness
- Altered sensation traveling down the back and sometimes into the limbs when bending the neck forward
11
Q
Diagnosis (NICE)
A
- Be aware that usually people with MS present with neurological symptoms or signs as described
- Are often aged under 50 AND
- May have a history of previous neurological ssymptoms AND
- Have symptoms that have evolved over more than 24 hours AND
- Have symptoms that may persist over several days/weeks and then improve
- Do not routinely suspect MS if a person’s main symptoms are fatigue, depression or dizziness unless they have a history or evidence of focal neurological ssymptomsor signs
- Before referral to neurologist must rule out alternative diagnosis
12
Q
Diagnosis
A
- Referral to a neurologist
- Medical history
- Neurological examination
- Medical investigations including MRI to identify areas of sclerosis in the brain or spinal cord (Mcdonalds criteria)
- Lumbar puncture to test for abnormality of the CSF
- Evoked potentials, to measure time taken for nerves to respond to electrical stimulation
13
Q
Disease to rule out
A
- Viral infections
- Lyme disease
- B12 deficiency
- CVA
- Lupus
- RA
- Other connective tissue disorder
- Vasculitis
- Syphilis
- TB
- HIV
- Sarcoidosis
14
Q
Molecular pathology of MS
A
- Peripheral riming of T cells by environmental factors (e.g. viral proteins)
- Migration of T cells across BBB in genetically susceptible host
- Local expression of pro-inflammatory mediators leads, to myelin damage, leucocyte infiltration across the BBB, chemokine release= central damage
15
Q
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16
Q
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20
Q
Clinical sub-types of MS
NB- you can move between sub-types
You are always symptomatic, on relapse these become worse
A
-
Relapsing-remitting MS (RRMS)
- Affects 85% of newly diagnosed
- Attacks followed by partial or complete recovery
- Symptoms may be inactive for months or years
-
Secondary-progressive MS (SPMS)
- Occasional relapse but symptoms remain constant no remission
- Progressive disability late in disease course
- ~50% of those RRMS develop SPMS during the first 10 years
-
Primary progressivee MS (PPMS)
- Affects 10-15% of MS population
- Slow onset but continuous worsening condition
- Symptoms become continuous
-
ProgressiveRelapsing MS (PRMS)
- Rarest form
- Affects ~5% of patients
- Steady worsening of conditions at onset
-
Benign MS
- 20% of MS patients
- Mild relapse followed by long periods of remission with little or no decline in function
28
Q
Fingolimod FTY720 Gilenya
A
- First oral agent for prevention of relapse
- Second line therapy (NICE- not cost effective)
- 0.5mg daily
- Modulation of lymphocyte S1P1 receptors
- Inhibits lymphocyte gressfrom the lymph nodes
- Prevents lymphocytes from infiltrating iinflammatory lesions in the CNS
35
Q
Therapeutic targets in MS
A
