Multiple Sclerosis Flashcards Preview

1. Neurology > Multiple Sclerosis > Flashcards

Flashcards in Multiple Sclerosis Deck (22)
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1
Q

What is MS?

A

inflammatory demyelinating disorder of the CNS, is it caused by an autoimmune reaction against myelin

2
Q

What is the epidemiology of MS?

A

females > males
occurs around 30s or 40s
first degree relative with MS = 12% chance you’ll get it
identical twin with MS = 33% chance you’ll get it

3
Q

What are the risk factors of MS?

A

vit D déficiency
Epstein Barr Virus
living far away from the equator

4
Q

What is the presentation of MS?

A

pyramidal dysfunction: increased tone, spasticity, weakness of extensors of upper limbs and flexors of lower limbs
lower urinary tract dysfunction
optic neuritis
intranuclear opthalmoplegia - failure of adduction and nystagmus in the abducting eye with lag in the other
fatigue

5
Q

What is the pathology behind MS?

A

plaques in the brain - show irregular, glassy appearance

6
Q

What are the two types of plaques in MS?

A

active

inactive

7
Q

Describe active plaques in MS?

A

perivascular inflammatory cells
ongoing demyelination and presence of microglia
demyelinating plaques are yellow/brown with an ill defined edge

8
Q

Describe inactive plaques in MS?

A

gliosis
little remaining myelinated axons and oligodendrocytes
well demarcated gray lesions in white matter

9
Q

Where do plaques commonly occur in MS?

A
brainstem
corpus collosum
spinal cord
cerebellum
optic nerves and chiasm
adjacent to lateral ventricles
10
Q

What is the pathogenesis behind MS? genes?

A

genes = HLA DRB
lymphocytic infiltration in histology
Th1 cells and Th17 cells do the damage
oligoclonal IgG bands in CSF

11
Q

How is MS diagnosed?

A

a least two episodes suggestive of demyelination - in different places at different times

12
Q

What is the first line investigation of MS?

A

MRI - lesions in white matter

13
Q

What are other investigations of MS?

A

lumbar puncture - oligoclonal bands in CSF

neurophysiology

14
Q

What is the management of an acute exacerbation/relapse?

A

mild - symptomatic treatment
moderate - oral steroids - methylprednisolone
severe - admit and give IV steroids

15
Q

What is the 1st line disease modifying drug for MS?

A

Tecfidera

16
Q

When would you give a 1st line DMD for MS?

A

2 moderate relapses in 2 years

17
Q

What is the 2nd line DMD for MS?

A

Tysabri and Ocreus - monoclonal antibody

18
Q

When would you give a 2nd line DMD for MS?

A

relapse after 1st line or really bad presentation

19
Q

What are 3rd line therapies for MS?

A

HSCT - stem cell transplant

Mitroxantrone or Lemtrada

20
Q

What is the role of Tysabri?

A

causes leukocyte apoptosis

but can cause PML in those with the JC virus - be careful

21
Q

What are the 4 possible pathways of MS?

A

relapsing remitting
secondary progressive (can turn into progressive relapsing)
primary progressive
progressive relapsing

22
Q

What is PML?

A

progressive multifocal leukaenceohalopathy - brain infection that may kill you