Multiple sclerosis overview

Question 1

MS causes

Answer 1

Myelin broken down by immune system - genetic and environmental impact

Question 2

Which areas of the brain are highly myelinated?

Answer 2

Corpus callous, white matter, cerebellum, pons, brainstem, spinal cord and optic nerve

Question 3

How do T and B cells contribute to MS?

Answer 3

They attack oligodendrocytes and destroy myelin (smouldering attack)

Question 4

Benign MS

Answer 4

Pt experiences areas of being stable and areas of relapsing but will remain at baseline level

Question 5

Relapsing emitting MS

Answer 5

Stable periods and relapsing periods, level of disability generally increases

Question 6

Secondary chronic progressive MS

Answer 6

A few years of stable periods and relapsing periods and then continuous relapses

Question 7

Primary progressive

Answer 7

From outset degenerates quickly

Question 8

Environmental factors increasing MS risk

Answer 8

Low vit D, pathogens, smoking, chemical exposure

Question 9

Dx MS

Answer 9

Test reflexes and check optic nerve for neuritis
MRI brain and spine - gadolinium enhancement for recent lesions
Lumbar puncture - OLIGOCLONAL BANDS

Question 10

Devic’s disease

Answer 10

Affects optic nerve and spinal cord but not brain, presents similarly to MS
To differentiate between Ddx and MS use CXR (MS has no changes), and blood tests

Question 11

Devic’s disease blood test

Answer 11

Anto-AQP4

Question 12

MS therapies

Answer 12

Steroids, IFn-B, tysabri, cladribine

Stem cell transplants

Question 13

DMARDS moa

Answer 13

v

Question 14

Fingolimid

Answer 14

Traps circulating lymphocytes in periphery to reduce CNS inflammation

Question 15

Lemtrada moa

Answer 15

Binds to CD8 receptor to destroy T cells

Question 16

prevention of MS

Answer 16

• Stop smoking
• Reduce salt
• Reduce weight
• Increase sun exposure
• Simvastatin, phenytoin, amiloride, riluzode are starting to be used