Week 5: Multiple Sclerosis Flashcards
What type of disease is MS?
An autoimmune disease
What does an autoimmune disease do?
Attacks healthy cells in the body
What are the two processes/features of MS?
Demyelination and astrogliosis with some axonal destruction
Inflammatory and neurodegenerative
What is astrogliosis?
Abnormal astrocyte levels due to the destruction of nearby neurons
- these support cells in the BBB, provide nutrients to cells etc
Does everyone experience MS the same?
No, very diverse experiences. How a person experiences MS depends on which part of the brain contains the affected neurons.
What is the role of an oligodendrocyte?
To produce myelin
What are the two types of white blood cells that help immune function?
B cells and T cells
What are B cells? and what do they do?
They are produced in bone marrow
- produce antibodies that ambush foreign antigens in the bloodstream
What are T cells? and what do they do?
They develop in the thymus gland (near the lungs)
- Directly attack foreign substances by attaching to them to send out cytokines. These cytokines direct other cells (B cells) to attack
What happens with T cells in the immune system of individuals with MS?
T cells start attacking healthy cells in the brain (neurons) and does so by attacking their myelin sheaths
MS lesions occur when….
How impactful are they on the individual
There is a lot of inflammation in the brain
- May have an impact on everyday functioning or they may go unnoticed
MRI success at looking at MS lessions?
Sometimes they cannot detect small fine grain changes
Why might lessions not impact MS individuals in everyday life?
We can find ways to adapt even if our brain is lesioned - this is because of brain plasticity
- However there may come a time where we can no longer compensate (or tap into other cognitive resources)
What are the main areas of the body affected by MS?
CNS: cog impairment, depression, unstable mood
Visual: optic neuritis, diplopia
Speech: dysarthria
Throat: dysphagia
Musculoskeletal: weakness, spasms, ataxia
Sensation: pain
Bowel: incontinence, diarrhea, constipation
Urinary: incontinence, frequency or retention
Why do so many individuals with MS live away from the equator?
Because they typically have temperature intolerance. They move to cooler climates to cope with this symptom
What is the typical age of MS onset?
Usually late 20s/early 30s
Are there any gender differences in MS?
2x as likely in females
Roughly how many people in Australia have MS?
About 24,000 people and rising
There is a common misdiagnosis with MS. What are people initially diagnosed with?
Depression
Which state in Australia has the highest MS prevalence?
Tasmania followed closely by Canberra
What are the different types of MS?
First demyelinating event Progressive-relapsing Secondary progressive Primary progressive Relapsing-remitting Benign
What is a first demyelinating event?
The first diagnosis before formal diagnosis
What is the progressive-relapsing type of MS?
Steady decline since onset with superimposed attacks
What is the secondary progressive type of MS?
Initial relapsing-remitting MS that begins to have declines without periods of remission.
Typically more women
What is the primary progressive type of MS?
Steady increase in disability without attacks
Very unique - only 5%
Typically more men
What is the relapsing-remitting type of MS?
Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission (continual relapse and remission)
This is usually the first diagnosis a person will receive
What does corticosteroid medication do?
Gives the neurons a chance to recover by reducing inflammation
What is benign MS?
Someone is diagnosed but then they never have another attack
If someone presents with more than 2 clinical attacks and evidence of more than 2 lesions, do you need any more information to diagnose them with MS?
No
What is a clinical attack?
A flare-up in the brain
If someone has had more than 2 attacks and evidence of one lesion, what else do they need to be diagnosed with MS?
An additional attack implicating another CNS site or an MRI
If someone has had one clinical attack and has evidence of more than 2 lessions?
Need an additional attack or CSF testing to be diagnosed with MS
What is CSF testing looking for with MS?
Looking for specific oligoclonal bands
If someone has had only one attack and only one lesion in the brain, what else do we need to be able to diagnose them with MS?
Need an additional attack OR one that implicates a different CNS site OR CSF testing
What is the EDSS? and what are the benefits of using it? what are its limitations?
Expanded Disability Severity Scales
Helps a neurologist keep track of the progression of MS symptoms overtime
It is not always appropriate however, as it focuses more on physical rather than cognitive
Is MS genetic?
It is likely that you can be genetically predisposed to MS
- but environmental agent that triggers immune-mediated response
MS is likely due to an interaction between several factors. What are they?
- Immunological
- Environmental - geography, vitamin d (white collar disease)
- Personal - gender, age
- Infectious factors - epstein-barr (glandularfever involved in modulating the onset of MS, triggers immune response and once it is on it is hard to switch off)
- Smoking
- Genetics - ethnicity (vikings disease), having a sibling or a 1st degree relative
How many people with MS experience cognitive impairments?
58%
What is considered the invisible symptom of MS?
Cognitive impairments associated with the disease
Cognitive impairments in MS are….
Heterogenous - no uniform pattern as can occur in different areas of the brain
Which cognitive areas are most affected in MS?
Processing speed Complex attention: divided & sustained attention New learning and memory Prospective memory Working memory Executive functions Social cognition
Which cognitive areas are least affected in MS?
General knowledge Intelligence Basic attention Language (other than word finding) Recognition memory Implicit memory
Why is processing speed declines a hallmark of MS?
Occurs because of myelin loss
- slowed nerve conduction
- signals find it harder to get through
What do processing speed challenges relate to?
Working memory challenges
What is the most reported symptom of MS? explain
Long term memory problems
But these are because of learning difficulties (encoding) rather than retrieval - slow processing - can’t keep up with what you’re experiencing
Visuospatial abilities in someone with MS?
May have visual disturbances due to optic nerve
- the optic nerve has a lot of myelin on it
Can result in difficulties with organizing visual information, seeing the relationship between objects and proprioception
How many of those with MS will have issues with visuospatial abilities?
1/4
…………. is less common than memory and processing speed but is still seen in MS
executive ability declines
What Executive functions are impaired?
Organisation Sequencing and planning Problem solving Sticky thinking - can't shift from one task to another Can't maintain focus with distractors
All because of slowed processing speed
Grey matter atrophy is related to….
the extent of cognitive deficits
Screening for cognitive decline early in the disease course plays a crucial role in what
clinical decision making, good for them to be involved while they still can be
When those with MS have cognitive impairments it is predictive of what?
Disability progression and cortical thinning
What are some of the social cognitions that may be impaired through MS?
Pseudobular affect: uncontrollable laughing and crying at inappropriate times
Emotion recognition: Impaired on fear and anger - typically negative emotions are difficult
Theory of mind: ability to see anothers perspective
Emotional liability: like pseudobular affect
Inappropriate behaviour
How many of those with MS have severe cognitive impairment?
10%
How is MS dementia different to normal dementia?
Basic language is intact
Orientation to place/person rarely affected
MS memory is more due to retrieval or acquisition in AD it is due to storage retention
What is plasma exchange?
The liquid portion of the persons blood is removed and separated from cells - then mixed with a protein and injected back in
What are immunosuppressants?
They suppress the immune system
What are immunomodulators?
They change the action of the immune system
How do maintenance therapies of MS work?
They are continuously administered and are only active in suppressing relapse when theyre being taken
- immunosupressants and immunomodulators
What are immune constitution therapies?
Treatment is administered for short periods of time but effectiveness lasts
- deplete immune system allowing it to repair itself
- closest thing to a cure
Stem cell treatments for MS?
It is not well understood how effective it is
- works for some people but it is very expensive and intensive
There is also a death rate involved
What is the process of stem cell treatment?
Cells moved from bone marrow to blood stream using chemo
Collect blood and separate stem cells
Cells are frozen
Chemo used to fully wipe bone marrow and immune system
Cells returned to body via drip
Body then recovers over a period of 3-6 months
There are no treatments for those with progressive MS - they need to rely on other things to manage their symptoms such as….
Physical therapy
Muscle relaxants
Medications to reduce depression, fatigue, pain, bladder and bowel problems
How to improve memory difficulties in MS?
use memory techniques: Repetition and rehearsal Increased exposure Write information down Visualise information Space learning overtime
How to improve processing speed in MS?
Take your time to interpret and learn
Have information repeated to you
How to manage fatigue?
Take regular breaks
Do important tasks when you are most alert
CBT - change perceptions of management
Can improved sleep quality improve cognition?
May improve own perspective of function instead of actual function
Can exercise improve cognition?
Improves verbal memory
Lowers inhibition errors
What are MS relapses typically associated with?
New lesions forming in the brain or spinal cord
Pseudorelapses?
Body reacting to things like infections, exercise or heat that flare up symptoms - will go away when the trigger is removed
Treatments for MS relapse should be given…..
as soon as possible in order to be effective
Concept of self in MS?
Changes in how they describe themselves - change multiple time as the disease progresses
