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A - Neuroinfectious Diseases Non-infectious Neurodiseases > Multiple sclerosis and Guillain-Barré > Flashcards

Multiple sclerosis and Guillain-Barré Flashcards

1
Q

Progressive neurodegenerative diseases:

A
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2
Q

main non-infectious neurodiseases / disorders

A

Progressive neurodegenerative diseases
Neuropsychiatric disorders

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3
Q

Neuropsychiatric disorders

A
  • Depression
  • Schizophrenia
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4
Q

Diseases of motor neurons and NMJ (properties)

A
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5
Q

Diseases of motor neurons and NMJ (examples)

A
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6
Q

Secondary neurodegenerative diseases

A

know cause and know not intrinsic

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7
Q

muscular dystrophies vs diseases of motor neurons and NMJ

A

not the same - issue is with muscles not with

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8
Q

GBS affects

A

Motor nerve axons, from spinal cord to muscles - PNS

Guillain-Barré syndrome

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9
Q

GBS is the most common

A

acute paralytic neuropathy
> 100,000 cases yearly

can affect anybody

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10
Q

GBS is a syndrome not

A

a disease - various subtypes

Spectrum of presentations, from very mild to very severe/fatal

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11
Q

GBS subtypes

A

Axonal subtype most severe

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12
Q

GBS is a reaction to

A

immune stimulation
- vaccines
- sickness/ infection

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13
Q

GBS develops

A

days/weeks after infection or vaccination

Molecular mimicry

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14
Q

Molecular mimicry is defined as

A

structural similarity between antigens coded by different genes

(definition in disease - Similarities between the antigens of a microbe and a host.)

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15
Q

GBS severity vs time

A
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16
Q

___ patients recover spontaneously in ___

A

Most
in 3 – 4 weeks
~70 % recover completely
~30 % retain residual weakness

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17
Q

___ develop into severe cases (GBS)

A

20 – 30 %

complete paralysis, including respiratory muscles

Rapid progression after onset, 3 – 4 days

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18
Q

GBS has strong evidence relating GBS with ___ bacteria

A

C. jejuni infection

LOS (lipooligosaccharides) in outer membrane = gangliosides in PNS axons

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19
Q

GBS associated with ____ viruses

A

flu, Zika, CMV (Cytomegalovirus), Epstein-Barr

20
Q

Antibody production in GBS

A

is random!

Correlations seen, still it is a sporadic disorder!

21
Q

GBS Immunopathology

A

mostly an humoral driven pathogenesis - Driven by serum (humoral - antibody- mediated) rxn. NOT cellular rxn.

antibodies against:
Against gangliosides in axonal membrane
(exposed at nodes of Ranvier)

Against broad range of myelin sheet
proteins (moesin was suggested)

22
Q

GBS Humoral effects

A

antibody deposits
complement activation
macrophage recruitment

23
Q

GBS prognosis

A

Potentially life-threatening disease, early diagnosis = better recovery

24
Q

GBS treatments

A

1) IV Ig infusion: addition of normal antibodies overcomes effect of autoreactive antibodies (many mechanisms, most end up reducing inflammation)

2) Plasma exchange: removal of autoreactive antibodies and other damaging humoral factors

25
Q

Severe cases ___ can achieve complete recovery

A

with physical therapy

26
Q

GBS in low income countries

A

these treatments are too expensive, so unavailable - new therapeutics are urgently needed

10 – 15 % of patients die - lack of treatment and medical support (in US more like 1-3%)

27
Q

MS is the most common __
also known as ___

A

autoimmune-mediated disease of the CNS
disseminated encephalomyelitis

28
Q

Global distribution of MS

A

~350,000 cases in US; 2.5 – 3 million worldwide

29
Q

MS age

A

Can strike at any age, but mostly 20 – 40 years old

Most common cause of permanent disability in young adults (stroke in older adults)

30
Q

MS telltale signs

A

Clinical spectrum (a lot of overlap) but

(SW S N P V)

sudden-onset muscle weakness
loss of sensation
numbness
pain
vision problems - unique + CNS

31
Q

MS epidemiology

A

geographically, diet
age (20-40)
women

32
Q

Men vs Women MS

A

Women 3X more likely

pregnancy is protective - hormonal effect? Or immunity?

not clear why - if have MS then get pregnant symptoms go away - when pregnant immunocompromised and ms is over immune rxn.

33
Q

MS Clinical presentation

A
  1. Relapsing-remitting MS
  2. Secondary-progressive MS
  3. Primary-progressive MS
  4. Progressive-relapsing MS

3-4 vary rare

34
Q

Ultimately MS becomes

A

steadily progressive

After 15 – 25 years of RRMS (relapsing-remitting), it turns into SPMS (secondary- progressive)

35
Q

Relapsing vs progressive MS manifestation

A

Relapsing - autoimmune inflammation

Progressive - neurodegeneration

36
Q

MS history

A

important - recurrence of isolated neurological symptoms

37
Q

MS MRI

A

best way to see lesions (an aggregation of immune cells)

Presence of lesions predicts MS development with > 80% accuracy

Size and number of lesions DO NOT correlate with severity – location most critical – however, steady increase correlates with severity

Use of contrast enhancing media shows BBB breaches due to inflammation

38
Q

Why does MS occour

A

don’t know what initially starts it
but is due to chronic inflammation

39
Q

MS progression pathology

A

White matter early on (mylen), then spread to grey matter

does not stop until pathogen (antigen/olog.) is gone

40
Q

Why MS is such a chronic disease with months of no symptoms between attacks?

A

Immune does not stop until pathogen (antigen/olog.) is gone - when gone Olig can regenerate - attack again

Is permanent is because the immune response is generated against self-antigens

41
Q

When myelin is destroyed in MS, the axon

A

redistributes the ion channels and switches to continuous signaling rather than saltatory conduction

42
Q

MS remylenation ocours because

A

OPCs (NG2 - oligodendroyte precusor cells) can generate oligodendrocytes

43
Q

As MS progresses, remission periods are

A

shorter and fewer

  • Correlates with decline in remyelination
  • With less remyelination, axon eventually dies
  • OPCs ability to differentiate declines with age
  • Once axonal death starts, progression into advanced MS is inevitable
44
Q

MS treatments

A

Current disease-modifying drugs targets the immune reaction, not the actual causative pathology - axonal destruction

No cure – but increasing arsenal of drugs makes it manageable
- Sadly, one of the leading causes of death in MS is suicide

Supportive treatments
- Amelioration of acute attack symptoms
- Anti-inflammatory agents

Very expensive – average costs per single dose is $60,000!

Many make you immunosuppressed, so susceptible to infections!

45
Q

MS and prions

A

MS excellent example that not all neurodegenerative diseases involve a prion-like component

1) Its all genetics and environment, and chance - (like) cancers

2) The 2 hits theory - applicable to many autoimmune diseases (2 hit - also in cancers)

A - Neuroinfectious Diseases Non-infectious Neurodiseases (5 decks)

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