Multiple Sclerosis other Flashcards
What is the pathological finding in PML?
This is a case of progressive multifocal leukoencephalopathy which is caused by JC virus; glassy plumb-colored intranuclear inclusions are found in oligodendrocytes in these cases, along with enlarged bizarre appearing astrocytes and areas of demyelination.
Following an episode of optic neuritis, what best predicts MS?
“After an episode of optic neuritis, the best predictor for subsequent MS is an abnormal MRI of the brain. CSF
findings do not add to the prognostic information available from brain MRI data.”
What is the likelihood of MS in a daughter of a patient?
“The daughter of a parent with multiple sclerosis has about a 5% chance of developing the disease. This
percentage is higher than siblings, with the exception of monozygotic twins.”
What is the most useful finding in CSF to assist with diagnosing MS?
Cerebrospinal fluid oligoclonal IgG bands are the most useful CSF abnormality for diagnosing MS. Additional
tests, such as IgG synthesis rate, IgG index, and myelin basic protein are less sensitive and less specific than
banding.
How is MS diagnosed?
The diagnosis of multiple sclerosis (MS) is considered to be clinically definite when there have been two attacks and there is clinical evidence of two separate lesions. This evidence must be an abnormality on
physical examination or on paraclinical testing such as evoked potential or imaging techniques. Pattern shift
visual evoked responses reveal abnormalities in over 90% of patients with a history of optic neuritis, even when
visual acuity has returned to normal.
A patient has CIS (optic neuritis) and abnormalities on MRI - what is the risk of developing MS?
The patient described has a clinical isolated syndrome of optic neuritis with an abnormal MRI scan of the brain. According to the 10-year follow up data of the Optic Neuritis Treatment Trial (2003), subjects with optic neuritis (of otherwise indeterminate cause) and abnormal brain MRIs at presentation had a 56% chance of being diagnosed with MS in 10 years.
Those with a normal brain MRI had a 22% chance.
What is EDSS?
The Kurtzke Expanded Disability Status Scale (EDSS) remains a key assessment tool in most drug trials performed for new multiple sclerosis therapies. Its ratings range from 0 to 10, with half points in between. There are eight sub scales, including pyramidal tract, visual and cognitive assessments; however, the overall ratings are highly dependent upon ambulatory ability.
What is the association with pregnancy and breastfeeding and relapses in MS?
“Neither pregnancy nor breastfeeding have been shown to adversely affect the course of RRMS using annualized relapse rates.
Breastfeeding may in fact be somewhat protective.
There is no known contraindication to corticosteroids during pregnancy.
What is the link with Smoking and MS?
Smoking is not only a risk factor for developing MS however, smoking in MS contributes to disability progression.
What is the pathology of MS?
Three processes:
1) inflammation - which can be acute and focal in new lesions/plawues, with accompanying demyelination, or more chronic and diffuse affecting lesions as well as non-lesional tissue
2) Acute neuro-axonal damage, be it directly due to inflammation or as a result of other processes
3) delayed neuroaxonal loss or neurodegeneration of chronically demyelinated or vulnerable neuroaxonal tracts
At the cellular level both T cells and B cells have been shown to cause MS changes
MRI findings in primary progressive MS
Enhancing lesions on MRI are uncommon
