Multiple Sclerosis Flashcards
MS: type of disease and target
- autoimmune disease
- target: CNS myelin
demyelinating lesions
- in gray AND white matter
- gray matter demyelination contributes to cognitive sx
- MRI does not show cortical demyelination
in MS, there is a shift to a ___-inflammatory state
in MS, there is a shift to a PRO-inflammatory state
-to treat, want to shift back to an anti-inflammatory state
cause of MS
- genetics
- infections (EBV)
- environmental exposure
- low vitamin D
age of onset of MS
20-40 years
-means they will have the disease for ~60 years
inflammation causes
- relapses
- new MRI lesions
neurodegenerative component of MS
- independent of relapses and new MRI lesions
- slow steady progression of disease
first sign of MS
-MRI lesion
______ is the most sensitive clinical tool for MS
MRI is the most sensitive clinical tool for MS
relapsing MS
- new attack every 1-2 years
- recover from attack
- cycle
radiologically isolated syndrome (RIS)
- have MRI lesions
- no clinical symptoms
- will likely have clinical sx in 5 years
_________ dominates in early phases of disease, _________ dominates in later phases
INFLAMMATION dominates in early phases of disease, NEURODEGENERATION dominates in later phases
treatment of MS is good at targeting ___________, but not _________
treatment of MS is good at targeting INFLAMMATION, but not NEURODEGENERATION
MS relapse
- acutely progressive neurological sx lasting 24 hours or more
- can be virtually any symptom
- early in disease, sx usually go away
symptoms of MS
- numbness, tingling
- walking difficulty
- vision problems
- weakness
- muscle spasms
MS treatment for relapses
- steroids, plasma exchange
- to reduce duration of symptoms
MS general treatment
- for Sx
- for relapses
- disease modifying therapy
disease modifying therapy for MS
- goal: put “brakes” on disease
- prevent relapses/MRI lesions/disabilty progression
diagnosis of MS
- can be completely clinical
- MRI is most valuable
- lumbar puncture: look for immune activity in CSF
- evoked potentials: look for demyelination elsewhere
MRI findings
T2/FLAIR
- radially oriented white matter lesions
- perivenular lesions
- brainstem, spinal cord
Gadolineum
T1 black holes (disability correlates well)
other potential diagnoses
- neuromyelitis optica spectrum disorder
- anti-MOG
- acute disseminated encephalomyelitis
- progressive multifocal leukoencephalopathy
- Lupus
- infections
- sarcoid
reduce/prevent disability by _________
reduce/prevent disability by TREATING EARLY
non-medication way to make a huge improvement of symptoms
- exercise
- diet
- lifestyle modification
- therapy
neuromyelitis optica spectrum disorder (Devic’s disorder)
NMO
- looks like MS
- hypothalamus and brainstem lesions
- antibodies against aquaporin 4
- poor prognosis with tendency to relapse
NMO features
- long spinal cord lesions
- involvement of gray matter near 4th ventricle
- pain, hiccups, severe weakness
- no oligoclonal bands
- IgG against aquaporin channels
- responds to tx with Rituxan
- some MS tx can worsen NMO
