Multiple Slcerosis (MS)

Question 1

What is MS?

Answer 1

Lymphocyte driven chronic disease. Usually diagnosed at the age of 20-40 years (median 30 years)

Question 2

What are two variable MS disease courses?

Answer 2

Relapsing and progressive

Question 3

What are risk factors for MS?

Answer 3

The risk factors of MS can be divided into three groups:

Genetic risk factors:

• antigen presentation
• T-lymphocyte apoptosis/proliferation
• Cell adhesion
• Lymphocyte development

Environmental:

• EBV virus (risk factor above all! CD8+ memory cells keep in control)
• Other herpes viruses?
• Smoking
• Alcohol
• Lack of UV-light in childhood
• Lack of vitamin D
• Teenage obesity

Early development:

• Lack of vitamin D
• T-cell development
• Month of birth-effect

Question 4

Genetic factors?

Answer 4

MS is not inherited, but there is a familial risk. Sequencing reveals enriched of CD8+ memory cells.

There is discovered at least 110 risk genes or genomic loci (that are active in leukocytes)

Question 5

What are the known mechanism of MS?

Answer 5

• In progressive MS, microglial activation plays more prominent role
• Evaluation through leukocyte dysfunction:
  1) Early development: CNS reactive lymphocytes
  2) Transformation: EBV and other risk factors
  3) Gradual growth of autoimmune genes

Question 6

Is there treatment for MS?

Answer 6

• Most effective way is lower body temperature
• Disease modifying drugs: based on immunomodulation, migration inhibition, cytotoxicity
  .Treatment for active bladder: botox injected to bladder wall, anticholinergic drugs inhibit bladder wall contractions, muscle training

Question 7

Diagnosis of MS?

Answer 7

• Exclusion of other causes
• Cerebrospinal fluid
• MRI (Brain and spinal cord)
• Symptoms and neurological signs