Multiple Sclerosis, GB syndrome, Myasthenia Gravis

Question 1

What is Multiple Sclerosis?

People with MS have flare ups causing different symptoms. Treatment focuses on managin symptoms/flare ups.

Answer 1

It’s an autoimmune disorder that causes the demyelination of the central nervous system.

Question 2

What sex and age group is MS most common in?

Answer 2

Female
20-40 years old

Question 3

Explain the pathophysiology of MS (5)

Answer 3

1. T cells cross the blood-brain barrier.
2. T cells recognize the myelin as foreign and attacks them.
3. T cells also damage oligodendrocytes.
4. Causes neuroinflammation
5. Affects sensory, motor, and cognitive functions

Question 4

What is the Charcot’s Neurologic Triad?

For MS

Answer 4

1. Difficulty of speech (brain stem)
2. Nystagmus (nerves of the eye)
3. Intention tremor (motor pathway of spinal cord)

(what part of the brain is affected)

Question 5

What are 3 medications someone with MS would be prescribed?

Answer 5

1. Corticosteroids
2. Cyclophosphamide
3. IV immunoglobin

Question 6

Name 5 complications of MS

8

Answer 6

1. Decreased mobility
2. Chronic diplopia
3. Chronic vertigo
4. Chronic dysphagia
5. UTI from bladder dysfunction
6. Constipation
7. Erectile dysfunctions
8. Mood disorders

Question 7

What is GB syndrome?

Answer 7

Autoimmune demyelinating disorder.
Characterized by acute symetrical ascending weakness.
Pt’s can make a full recovery.

Question 8

Quickly explain the pathophysiology of GB

Answer 8

• B cells create antibodies to fight GI or respiratory infection.
• Antibodies start to target myelin sheath = demyelination
• Damages the neurons

Question 9

What causes GB

Answer 9

It’s triggered by a GI or respiratory infection.
Can also be caused by surgery or trauma.

Question 10

What are signs and symptoms of GB

6

Answer 10

• Neuropathic pain
• Ascending weakness/paralysis (starts in the extermities)
• Numbness, tingling, or burning sensation in the extremities
• Peripheral loss of sensation
• Absent or hyperreflexes
• Loss of proprioception

Question 11

What are some complications of GB

Answer 11

• Pulmonary embolism (leading cause of death in GB)
• Paralysis of the diaphragm leading to respiratory failure

Question 12

What is the treatment/management of GB

4

Answer 12

• IV immunoglobins
• Plasma exchange
• Supportive care
• Blood thinner (to prevent PE)

Question 13

What is myasthenia gravis

Answer 13

Autoimmune disorder that causes muscle weakness. Non-currable, life-long disease

Question 14

Quickly explain the pathophysiology of myasthenia gravis

Answer 14

• Acetylcholine (ACh) is the neurotransmitter present at neuromuscular junctions
• The immune system makes ACh receptors antibodies which bind to the post synaptic receptors. ACH can no longer bind to receptors
• Muscle cannot be stimulated to contract
• Damages the post-synaptic membrane

Question 15

Signs and symptoms of myasthenia gravis

Answer 15

• Weakness
• Double vision/diplopia
• Drooping eyelids
• Difficulty swallowing
• Trouble with facial movement
• Slurred speech
• Weakness that worsens with activity

Question 16

What are the key characteristics of myasthenia gravis

Answer 16

• Weakness worsens with activity.
• Weakness gets better with rest (usally at it’s best in the morning)

Question 17

What is the treatment for myasthenia gravis

Answer 17

• IV immunoglobins
• Plasma exchange
• Acetylcholinesterase inhibitors (stops the breakdown of ACh and increases it’s concentration)
• Immunosupressive drug (reduces the production of antibodies)
• Surgical removal of the thymus

Question 18

What is a myasthenic crisis

Answer 18

Severe, life threatning condition caused by an acute worsening of symptoms. It can cause respiratory failure.