Neuro - MS Flashcards
Describe MS
A chronic autoimmune disorder that progressively robs suffers of cognitive function, the ability to sense the world around them and the capacity to walk
What are the clinical features of MS?
Vision problems Numbness Difficulty walking Fatigue Depression Emotional changes Vertigo and dizziness Sexual dysfunction Coordination problems Balance problems Pain Changes in cognitive function Bowel/bladder dysfunction Spasticity
Are women or men more affected by MS?
Women 2:1
What is the age of onset of MS?
18-50 (young adulthood) varies
What part of the world is more likely to get MS?
Northern latitudes with people moving o northern latitudes before 15 at the biggest risk
Is MS a severe life-limiting disease?
No only 5-7 year shorter but the quality of life is reduced
What are the 4 types of MS?
Relapsing-remitting MS (RRMS)
Secondary-progressive MS (SPMS)
Primary-progressive MS (PPMS)
Progressive-relapsing MS (PRMS)
Describe RRMS
85% of people affected
Attacks followed by partial or complete recovery
Symptoms may be inactive for months or years
Describe SPMS
Occasional relapses but symptoms remain constant, no remission
Describe PPMS
Affects approximately 10% of MS population
Slow onset but continues to get worse
Describe PRMS
Rarest form approx 5%
Steady worsening of condition at onset
How is MS diagnosed?
Disease in two parts of the nervous system and signs of at least two separate flare-ups occurring at least 30 days apart
McDonald criteria for an early and accurate diagnosis
What are the characteristic of neuropathy
Inflammation
Multifocal areas of demyelination
Involves immune system and neurological system
continual deposition of sclerotic plaques
Plaques are commonly in white matter
Present in the brain, brain stem, optic nerve and spinal cord
Lesions formed from infiltration of lymophocytes and macrocytes
Can MRI detect demyelinating lesions in the brains spinal cord?
Yes
Can observe the recovery of plaques/myelination in relapsing MS
How many types of cortical lesions are there?
3 types - 1/2/3
What are the differences in the types of cortical lesions which lead to neuronal damage?
See diagram
Type 1 in the centre
Type 2 smaller and focussed
Type 3 outside of cortex
What happens to movement when demyelination occurs?
Slows down electrical impulses and therefore movement is slowed down
Does the pathology of MS change of time?
Yes
Draw the diagram of the involvement of the immune system in pathophysiology
See diagram
What are the environmental factors which can influence MS?
Pathogens - molecular mimicry
Chemicals
Diet
Geography
What are the gene factors which can influence MS?
Genome allelic variations
Monozygotic twins ~30%
Linnkage and association studies
What are the post-genomic modifications which can influence MS?
Gene rearrangements
Somatic mutations
Retroviral
mRNA splicing
Vitamin D defiency
Vitamin D3 receptor is important in immune function
Present on T regulator cells
Vitamin D and sunlight may slow MS
Infectious mononucleosis/ EBV
99% of MS patients have detectable EBV titers
Extractable nuclear antigen (ENA) levels increase MS
EBV RNA transcripts (EBER) found in inflammatory lesions
EBV stimulates Toll 3 receptors to release proinflammatory interferons
Treatments involve relieving the symptoms of MS
- Anti-depressents
- Laxatives
- Anti-convulsants
Treatments involved in slowing the progression of MS
ABC treatments
Chemotherapeutic agents
Corticosteroids and ACTH
What are the complementary and alternative medicines for MS?
Excercise - maintains core stability and posture
Cooling -symptoms are worse when core temperature rises
Vitamin D - supplementation or sunlight
What are the names of the drugs in the ABC treatment and which ones have been added?
Avonex - a form of interferon beta-1a
Betaseron - a form of interferon beta-1b
Copaxone - the immunomodulator Glatiramer acetate
Added: Rebif (interferon beta-1a) and Novantrone (antineoplastic mitoxantrone)
All work by regulating aspects of the immune system
Are the new drugs in development?
Lots of drugs in clinical trials and some have been approved
