Multiple Sclerosis (Balashov) Flashcards
Describe the key factors implicated in MS pathogenesis.
Immune-mediated disease of CNS
Associated w:
- INFLAMMATION
- DEMYELINATION
- AXONAL LOSS / NEURODEGENERATION
MS = clinical diagnosis -> no “MS-specific laboratory test”
Symptoms of MS
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
Review the basic of current diagnostic criteria for MS.
- 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
Describe the use of MRI in diagnosing MS.
Contrast enhancing lesions
Discuss other common diseases that can mimic MS.
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)
List, generally, the drugs used to treat MS acute episodes and chronic symptoms.
Acute:
- High-dose IV steroids (methylprednisolone IV for 5 days)
- ACTH
- Plasmapheresis
- IVIg
Describe drugs called disease-modifying treatment (DMT) for MS.
BG 12: 2nd generation fumaric acid ester
Natalizumab: humanized monoclonal antibody
Fingolimod: S1P receptor
Teriflunomide: reversibly inhibits mitochondrial enzyme for pyrimidine synthesis
