S13 Multiple Sclerosis Flashcards
What is optic neuritis?
Inflammation the optic nerve, causing pain and loss of vision. Good prognosis, high dose steroids speed up rate of recovery. (50% develop MS).
What is transverse myelitis?
Inflammation of the spinal cord, often purely sensory - results in Lhermittes phenomenon (electric shock when bending neck).
50% develop MS.
What are the diagnostic criteria for MS?
Optic neuritis and transverse myelitis occurring at different times.
Epidemiology of MS?
2F : 1M. 30-40y/o. More common further away from equator.
What is the pathology behind MS?
Inflammatory reaction causing loss of myelin and slowing of nerve conduction. May be immune mediated or antibody mediated.
What tare the disease modifying treatments in MS?
Interferon beta 1-a/b.
Natalizumb.
What effect does interferon beta have on MS? What is its main side effects?
Reduces relapses by a third.
Effective early in the disease course but not longer term.
Flu like symptoms and injection site reaction.
How does TYSABRI/Natalizumab work?
Blocks α4 ingtegrin on leukocytes from associating with VCAM-1. Thus preventing migration into brain.
Natalizumab can cause a condition with 60% mortality - what is it and how is prevented?
Causes Progressive Multifocal Leukoencephalopathy in people with the JC virus. If JC positive, patients are moved off TYSABRI after two years.
Name three new oral treatments for MS.
Fingolimod.
Terifunomide.
Dimethyl Fumarate.
How does Fingolimod (an MS drug) work?
Side effects?
Makes T cells internalise Sphingosine 1-phosphate (S1P) receptor. Traps circulating lymphocytes in peripheral lymph nodes.
Lymphopenia and bradycardia.
What are the four types of disease progression in MS?
Relapsing-remitting.
Primary progressive.
Secondary progressive.
Progressive relapsing.
