Multiple Sclerosis

Question 1

MS: type of disease and target

Answer 1

• autoimmune disease

- target: CNS myelin

Question 2

demyelinating lesions

Answer 2

• in gray AND white matter
• gray matter demyelination contributes to cognitive sx
• MRI does not show cortical demyelination

Question 3

in MS, there is a shift to a ___-inflammatory state

Answer 3

in MS, there is a shift to a PRO-inflammatory state

-to treat, want to shift back to an anti-inflammatory state

Question 4

cause of MS

Answer 4

• genetics
• infections (EBV)
• environmental exposure
• low vitamin D

Question 5

age of onset of MS

Answer 5

20-40 years

-means they will have the disease for ~60 years

Question 6

inflammation causes

Answer 6

• relapses

- new MRI lesions

Question 7

neurodegenerative component of MS

Answer 7

• independent of relapses and new MRI lesions

- slow steady progression of disease

Question 8

first sign of MS

Answer 8

-MRI lesion

Question 9

______ is the most sensitive clinical tool for MS

Answer 9

MRI is the most sensitive clinical tool for MS

Question 10

relapsing MS

Answer 10

• new attack every 1-2 years
• recover from attack
• cycle

Question 11

radiologically isolated syndrome (RIS)

Answer 11

• have MRI lesions
• no clinical symptoms
• will likely have clinical sx in 5 years

Question 12

_________ dominates in early phases of disease, _________ dominates in later phases

Answer 12

INFLAMMATION dominates in early phases of disease, NEURODEGENERATION dominates in later phases

Question 13

treatment of MS is good at targeting ___________, but not _________

Answer 13

treatment of MS is good at targeting INFLAMMATION, but not NEURODEGENERATION

Question 14

MS relapse

Answer 14

• acutely progressive neurological sx lasting 24 hours or more
• can be virtually any symptom
• early in disease, sx usually go away

Question 15

symptoms of MS

Answer 15

• numbness, tingling
• walking difficulty
• vision problems
• weakness
• muscle spasms

Question 16

MS treatment for relapses

Answer 16

• steroids, plasma exchange

- to reduce duration of symptoms

Question 17

MS general treatment

Answer 17

• for Sx
• for relapses
• disease modifying therapy

Question 18

disease modifying therapy for MS

Answer 18

• goal: put “brakes” on disease

- prevent relapses/MRI lesions/disabilty progression

Question 19

diagnosis of MS

Answer 19

• can be completely clinical
• MRI is most valuable
• lumbar puncture: look for immune activity in CSF
• evoked potentials: look for demyelination elsewhere

Question 20

MRI findings

Answer 20

T2/FLAIR

• radially oriented white matter lesions
• perivenular lesions
• brainstem, spinal cord

Gadolineum

T1 black holes (disability correlates well)

Question 21

other potential diagnoses

Answer 21

• neuromyelitis optica spectrum disorder
• anti-MOG
• acute disseminated encephalomyelitis
• progressive multifocal leukoencephalopathy
• Lupus
• infections
• sarcoid

Question 22

reduce/prevent disability by _________

Answer 22

reduce/prevent disability by TREATING EARLY

Question 23

non-medication way to make a huge improvement of symptoms

Answer 23

• exercise
• diet
• lifestyle modification
• therapy

Question 24

neuromyelitis optica spectrum disorder (Devic’s disorder)

Answer 24

NMO

• looks like MS
• hypothalamus and brainstem lesions
• antibodies against aquaporin 4
• poor prognosis with tendency to relapse

Question 25

NMO features

Answer 25

- long spinal cord lesions - involvement of gray matter near 4th ventricle - pain, hiccups, severe weakness - no oligoclonal bands - IgG against aquaporin channels - responds to tx with Rituxan - some MS tx can worsen NMO