Multiple Sclerosis- epidemiology Flashcards
Does MS affect women or men more
women
Do adolescence get MS
it is uncommon
At what age is the most common onset of MS
between 20 and 40 years old
Can people in their 60s get MS
uncommon after 60, but the disease can be very mild until 60, then require medical intervention
Geographical Pattern of Prevalence - which countries are at more risk and least at risk
High risk areas
Northern US, Northern Europe, Southern Canada, New Zealand, Southern Australia
Medium risk areas
Southern US and Europe, Northern Australia
Low risk
Africa, Asia
Migration patterns & epidemiological studies have revealed that where a person spends the 1st 15 years of life determines the likelihood of developing MS
If you were born in the north and move to the south at 17, higher risk
If you were born in the south and move north at 17, lower risk
If you were born in the north and move south at 10, lower risk
If you were born in the south and move north at 10, higher risk
What do geographical patterns of MS tell us?
Indicates an environmental trigger (e.g. virus)
Exposure to Viral Agent
Molecular Mimicry
Immune system responds to viral agent with activated myelin-reactive lymphocytes
Implicated Viruses, yet to be proven Epstein-Barr Measles Canine Distemper Human Herpes Virus-6 Chlamydia pneumonia
Genetics and MS
Risk of developing MS is greater if you have a sibling with MS, greater risk for ♀ sibling vs. ♂ sibling
3% for sibling
5% for fraternal co-twin
25% for identical co-twin
Risk is 1 in 750 for getting MS in the general population, but 1 in 40 for someone with a family history of MS
Favorable prognostic indicators:
Female, onset before age 35, monoregional vs polyregional attacks, and complete recovery after attacks
Unfavorable prognostic indicators: For MS
Male, brainstem symptoms (ataxia, nystagmus, tremor, dysarthria), poor recovery after exacerbations, & high frequency of attacks
What is monoregional vs polyregional attacks?
monoregional vs polyregional - one area of attack as suppose to multiple area of attack
What should someone do if they are getting an MS exasperation
Go to the hospital right away and get steroids so you can reduce damage
What are the 4 types of MS
Relapsing-Remitting (RR)
Primary-Progressive (PP)
Secondary-Progressive (SP)
Progressive-Relapsing (PR)
What is Myelocortical MS (MCMS)*
Is a new sub-type of MS identified in 2018.
It is marked by demyelination of the spinal cord and cerebral cortex but not of cerebral white matter.
Neuronal loss with no demyelination of the white matter
Neurons become swollen and look like typical MS lesions indicative of white matter myelin loss on MRI
Indistinguishable from traditional MS on MRI
Relapsing-Remitting MS
Episodes of rapid, abrupt & unpredictable deterioration with variable degrees of recovery over time & minimal residual disability Periods btw relapses are characterized by lack of disease progression Most common (85-90%)
Can RR develop into something else?
After 10-15 years, will develop into progressive MS in 30-40% of individuals
50% need assistive devices 15 yr post onset
40% with attacks rendering them nonambulatory never regain ability to ambulate
How is RR characterized?
Characterized by clearly defined acute attacks with full recovery or with sequelae & residual deficit upon recovery.
Periods between disease relapses are characterized by lack of disease progression.
Primary-Progressive
is
Characterized by a steady progression of continuous worsening with minor fluctuations, but without distinct periods of relapses and remissions
Plateaus rather than remissions
Aka relapsing-progressive
Tends to affect people who are older at disease onset
Approximately 10%
PP characterized by
Characterized by disease showing progression of disability from onset, without plateaus or remissions (A) or with occasional plateaus & temporary minor improvements (B).
Secondary Progressive
is
Begins as relapsing-remitting (85-90%), followed by progression with or w/o occasional relapse, minor remission, or plateau
The decline may include new neurologic symptoms, worsening cognitive function, or other deficits.
SP initial course
Begins with an initial RR course, followed by progression of variable rate that may also include occasional relapses & minor remissions.
Progressive-Relapsing is
Steady progressive deterioration from onset with clear, acute relapses that may or may not resolve
Periods between relapses are characterized by continued progression
Pace of deterioration can vary
The least common of all MS sub-types
Which type of MS is one of the more aggressive types
PR
PR shows
Shows progression from onset but with clear acute relapses with or without full recovery.
What does Myelocortical MS tell us?
Neurodegeneration and demyelination can occur independently in MS
What is the most common form of MS?
RR- most people with this live a normal life.
Is there medication for MS
most of the medication for MS treats RR. It potentially delays the frequency of relapses -> less long term damage
Why might someone not the the medicine for MS?
The Side Effects
B&B issues
Nausea
Visual Deficits
After 10-15 years of RR what might happen to 40% of people
they will develop a progressive form of MS
Which type of MS is a general slow decline?
PP
For the 40% of people with RR that gets progressive, what does it turn into?
SP
To confirm MS by MRI, the MRI has to be
Temporally and Spatially distinct
How do you further confirm MS and what would you see?
Lumbar puncture, you will see an increase of gamma globulins and WBC in the CSF
How is primary progressive MS diagnosed
In primary progressive MS, a slow progression of s/s over at least 6 months is required for diagnosis
What are the 3 common impairment Measures
MFIS – Modified Fatigue Impact Scale
MS Quality of Life Inventory
EDSS – Expanded Disability Status Scale
