Multiple sclerosis Flashcards
what is multiple sclerosis
chronic inflammatory and degenerative disease of the central nervous system
what characterises MS
inflammation
demyelination +/- variable extent of remyelination
neuronal injury/loss
astrogliosis
what are the risk factors for MS
genetics play a part
vitamin D deficiency
smoking
Epstein-Barr virus
obesity
can have every risk factor and still not get MS
what are the clinical features of MS
begin with attacks of symptoms (relapsing-remitting MS) where there is a focal area of scarring in a clinically eloquent area of the brain
reaches a point where patients can’t recover from these relapses and get progressively worse (secondary progressive MS)
what occurs in secondary progressive MS
diffuse activation of microglia and diffuse loss of neural tissue known as neurodegeneration
what is primary progressive MS
continuously degenerating MS
how is MS diagnosed
diagnosis of exclusion
history/examination (dissemination in space and time)
tests to support diagnosis such as lumbar puncture and MRI
diagnostic criteria are called the Mcdonald criteria
what is dissemination in space and how is it determined
lesions that have occurred in different anatomical regions
can be determined using MRI
what is dissemination in time and how is it determined
separate events that don’t occur at the same time
contrast called gadolinium will show dissemination of time as acute lesions upon MRI will show leakiness, whereas, more longstanding lesions will not
from a lumbar puncture oligoclonal bands in CSF that don’t match up with the serum bands indicate there is inflammation in the brain not present in the blood, shows dissemination in time
what is the treatment for MS
mostly for the relapsing-remitting stage
immunosuppressant and immunomodulatory for relapsing-remitting stage known as disease-modifying therapies
for the progressive stage there is no treatment, focus on management
