Multiple Sclerosis

Question 1

What is the risk of MS if a first degree relative is affected?

Answer 1

2-4% (compared with 0.1% in general population)

Question 2

Which HLA increases risk of MS?

Answer 2

HLA DRB1*1501

Question 3

What are risk factors for MS?

Answer 3

family history
EBV and mononucleosis
temperate latitude
toxins
trauma
low vitamin D
smoking
obesity
female

Question 4

Is axonal damage present in MS?

Answer 4

yes -> leads to neurodegernative ‘progressive’ phase

Question 5

What are the 4 clinical types of MS?

Answer 5

relapsing remitting (85%)
secondary progressive
primary progressive

Question 6

What is a pseudorelapse?

Answer 6

a conduction block in previously demyelinated axons (often due to elevated temperature)

Question 7

What is the most important diagnostic technique for MS?

Answer 7

MRI

Question 8

How can you show dissemination in time on the one MRI?

Answer 8

simultaneous enhancing lesions and non enhancing lesions

Question 9

How can you assess neurodegeneration on MRI?

Answer 9

by measuring the size of the brain or the spinal cord

Question 10

Are oligoclonal bands specific for MS?

Answer 10

no

Question 11

What is the treatment for acute relapses?

Answer 11

glucocorticoids and PLEX

Question 12

What is the mechanism of action of natalizumab?

Answer 12

monoclonal antibody against alpha4-integrin - prevents leukocytes crossing BBB

Question 13

What is the risk of PML with nataluzimab?

Answer 13

1 in 500

Question 14

In which patients is fingolimod contraindicated?

Answer 14

recent MI, unstable angina, stroke, AV block, sick sinus, prolonged QT

Question 15

In which patients with cladribine contraindicated?

Answer 15

current malignancy