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Brain and Behaviour Year 2 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis

A
  • this is an autoimmune inflammatory disease that attaches myelinated axons in the centre nervous system
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2
Q

How do you recognise MS

A
  • patients medical history

- physical examination

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3
Q

What is an episode of multiple sclerosis defined as when investigating multiple sclerosis

A
  • Current neurological symptoms or a previous neurological episode lasting at least 24 hours without evidence of infection, fever or encephalopathy
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4
Q

What are the most common symptoms of multiple sclerosis

A
  • sensory and motor problems - can experience numbness or tingling down arms and legs, or an electric current sensation down he back of the legs or useless hand syndrome
  • vision problems; vision blurriness or loss or diplopia
  • slow progressive or subacute motor defeicts
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5
Q

What symptoms of MS occur in less than 5% of patients

A
  • Bladder dysfunction
  • Heart intolerance
  • Paroxysmal symptoms
  • Pain
  • Movement disorders
  • Dementia
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6
Q

When do patients with MS tend to feel worse

A

People tend to feel worst when there is heat, temperature change in their symptoms and they can have recurrence of symptoms typically the vision loss, but other things can show up and when they cool down this then disappears
- this is because heat causes nerves to conduct less efficiently

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7
Q

what are the types of MS that can occur

A

relapsing remitting
primary progressive
secondary progressive

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8
Q

describe the three types of MS that can occur

A

relapsing remitting
- this is when an attack will occur but then go back to baseline - this is the most common type and affects 75-90% of patients

primary progressive
- patient never relapses and progressively gets worse

secondary progressive
- between relapses the disease gets worse

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9
Q

even if the patient does not …

A

even if patient does not have a lot of relapses the disease may be progressing sub clinically.

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10
Q

what do we mean by relapse in MS

A
  • inflammation waves entering the brain
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11
Q

what part of the brain do lesions tend to be in in MS

A
  • periventricular, they can be in any part of the brain but need to have a periventricular lesions
  • there are some cases in which the spinal cord will have a lesion and the brain won’t
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12
Q

What type of MRI scan can be used for spotting inflammation in multiple sclerosis

A

T2/FLAIR lesions

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13
Q

what contrast can be used to enhance the areas of inflammation

A
  • gadolinum
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14
Q

describe what the MRI has to show for MS to be diagnosed

A

T2/FLAIR lesions disseminated in space: (>1 area) in >= 2 CNS areas

  • lesions can be in periventricular, juxtacortical, infratentorial, or spinal cord
  • *Lesion in corpus callosum is also indicative of MS because they are rare in other conditions

and

  • *T2/FLAIR lesions disseminated in time (ie, occurring at different points in time)
  • e.g. 1 lesion at baseline and then, on follow-up MRI, have a new T2 and/or Gd-enhancing lesion
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15
Q

what else can the MRI show in MS

A

can show brain atrophy

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16
Q

How do you diagnose MS

A

MRI and lumbar puncture

17
Q

How does a lumbar puncture show that you have MS

A
  • done in sterile environment with atruamtic needle which means that there is no damage to the dura
  • it compares components of the CSF to the plasma (such as presence of blood cells and lymphocytes)
  • measures neurofilaments - if the neurofilamnets are high than it is indicative of ongoing nerve loss
18
Q

what are neurofilaments

A

= neurofilaments are the protein component of axons

19
Q

what are olgioclonal bands

A
  • can see olgiocloncal bands in the CSF and not in the plasma = this is a hallmark of chronic inflammatory process
20
Q

How do you diagnose MS

A
  • Neurological symptoms need to occur in more than one place in the CNS (brain, spinal cord, optic nerve) (dissemination in space) AND
  • It needs to be a chronic condition i.e. two different points (dissemination in time).
  • Rule out all other diagnoses.
21
Q

what are the two important things in diagnosis of MS

A
  1. Time is important in diagnosis – by definition it is a chronic disease so you have to show that it is not a one off therefore lesions should be seen at two different times
  2. it should not only affect one part of the nervous system, there should be lesions in different part of the nervous system
22
Q

Why do we have a diagnostic criteria

A
  • We have a diagnostic criteria so we can have a homogenous population so we can test a drug or treatment
  • sometimes you have to be able to make a diagnosis so that we can treat
  • to rule out other possible diagnosis
23
Q

what are other differential illnesses in comparison to MS

A
  • Cerebrovascular disease
  • Syphilis
  • Lyme borreliosis
  • SLE
  • Vitamin B12 deficiency
  • Rare hereditary diseases
24
Q

describe the genetic component of MS

A

There is a genetic component but it is not very relevant (in terms of producing offspring chances are relatively low).

25
Q

what gene is MS associated with

A
  • HLA-DRB11501-DQB10602 haplotype on chromosome 6p21 western populations
26
Q

What are the causes of MS

A

• The cause of MS is relatively unknown. Can possible due to:
o Viral infection of neurons.
o Mitochondrial dysfunction.
o Release of heat shock.

27
Q

inflammation versus neurodegernation

A

= not sure if MS is caused by the inflammation causing neurodegernation or the neurodegernation causing inflammation

28
Q

what is the pathology of MS

A
  • this is when axons are still present but there is no myelin around them
29
Q

What are the cells involved in MS

A
  • Neurons
  • Astrocytes (reactive astrocytosis)
  • Oligodendrocytes = pathology most seen in this
  • Microglia
30
Q

what is a proactive lesion

A
  • activated microglia and loss of myelin

- lymphocyte infiltration around the blood vessel

31
Q

what is a chronic active lesion

A
  • lymphocyte spread out around the lesions

- macrophages engulf myelin and sit on the lesions edge

32
Q

what is a chronic inactive lesions

A
  • attempt at demyelination
  • however there is already significant demyelination and axonal loss
  • forms an astrocytic scar
33
Q

what are the two types of treatment programmes that can be used in MS

A

escalation
- this is when you start with a drug that is not very effective but has less side effects and if the disease breaks through then you prescribe a better drug

induction
- this is when you go early and hit hard with the most effective drugs in the hope that you can preserve things for as long as possible

34
Q

name some first line and second line escalation drugs

A

First line

  • Injectables = IFNb and GA
  • Orals – DMF and teriflunomide
  • Ocrelizumab – monoclonal antibodies - IV
  • Natalizumab – monoconal antibodies – blocks the activation marker for lymphocytes that go into the blood brain barrier - IV
  • Cladribine – anti proliferation drug

Second line (more aggressive)

  • Fingolimod - oral
  • Natalizumab - IV
  • Cladribine - oral
  • Alemtuzumab - IV
35
Q

name some induction drugs that are used

A
  • Alemtuzumab – a anti CD52 - IV
  • Mitoxantrone
  • HSCT
  • Ocrelizumab- IV
36
Q

what drug is used in attacks of inflammation

A

high dose prednisolone

Brain and Behaviour Year 2 (36 decks)

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