Multiple Sclerosis (Balashov)

Question 1

Describe the key factors implicated in MS pathogenesis.

Answer 1

Immune-mediated disease of CNS

Associated w:

• INFLAMMATION
• DEMYELINATION
• AXONAL LOSS / NEURODEGENERATION

MS = clinical diagnosis -> no “MS-specific laboratory test”

Question 2

Symptoms of MS

Answer 2

Blurred vision (OPTIC NEURITIS)
Double vision
Weakness (UMN signs/CNS lesions... e.g., MYELITIS)
Impaired coordination
Numbness
Cognitive dysfunction
TRIGEMINAL NEURALGLA
Fatigue (most common symptom)
Bladder dysfunction

Question 3

Review the basic of current diagnostic criteria for MS.

Answer 3

• At least 1 objective clinical episode with neurological symptoms lasting for 24 hours or longer (w/ no symptomatic infection)
• Dissemination in time (e.g., second clinical episode or new lesion on follow up brain MRI)
• Dissemination in space (e.g., “multifocal” symptoms or multiple CNS lesions on MRI)
• Exclusion of common disorders which can mimic MS (clinical history, MRI, lab tests)

CSF:

• Elevated IgG
• Oligoclonal bands (result from synthesis of large amounts of relatively homogenous immunoglobulins)
• Exclude other diseases

Question 4

Describe the use of MRI in diagnosing MS.

Answer 4

Contrast enhancing lesions

Question 5

Discuss other common diseases that can mimic MS.

Answer 5

Infection (Lyme)

Inflammatory (SLE, Sarcoidosis, Neuromyelitis optics - inflammatory demyelination of optic nerves and spinal cord, ADEM - acute disseminated encephalomyelitis)

Metabolic (B12 deficiency)

Cervical or thoracic spondylosis (osteoarthritis)

Question 6

List, generally, the drugs used to treat MS acute episodes and chronic symptoms.

Answer 6

Acute:

• High-dose IV steroids (methylprednisolone IV for 5 days)
• ACTH
• Plasmapheresis
• IVIg

Question 7

Describe drugs called disease-modifying treatment (DMT) for MS.

Answer 7

BG 12: 2nd generation fumaric acid ester

Natalizumab: humanized monoclonal antibody

Fingolimod: S1P receptor

Teriflunomide: reversibly inhibits mitochondrial enzyme for pyrimidine synthesis