Lecture 5: MS Flashcards Preview

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Flashcards in Lecture 5: MS Deck (27):
1

Demyelination

disruption of myelin that coats neurons; makes the AP transmit slower

2

Multiple sclerosis definition

an idiopathic inflammatory demyelinating dz of CNS ; caused by an autoimmune attack on oligodendrocytes

3

Hallmark of MS

multiple scarred foci (plaques) with in the white matter of CNS and perivenular inflammation
-lesions primarily in white matter

4

MS Pathophysiology:

under inflammatory cndtns T cells, B cells, macrophages, granulocytes cross BBB and enter CNS; once inside target self antigens on oligodendrocytes, decreasing myelin production

5

Demographics of MS

-age preference: 15-55
-gender preference: females = 2:1
-Genetics
-Environment: born in northern states: 3x higher likelihood

6

Sx's of MS: Episodic relapses

-occur during different periods, but are short lived
-progress over hrs to days
-improve over days to weeks

7

Chronic Sx's of MS

heat sensitivity; bowel/bladder/sexual dysfxn; fatigue; mood disorders; cognitive dysfxn; gait impairment

8

Most common Sx's of MS

Limb sensory loss
Visual Loss: optic neuritis
Other: subacute weakness, diplopia, gait disturbance; balance probs; acute weakness

9

Transverse myelitis

-sensory loss in one or both limbs
-L'hermitte's phenomenon: when flex neck have sharp shooting tingling down length of spinal cord
-MS hug: feeling of tightness around chest

10

Optic neuritis

-eye pain; decrease acuity
-optic disc edema

11

Dx of MS: 2 things must have

1) dissemination in space
2) dissemination in time

12

MS MRI

-diagnostic test of choice
-T2/Flair: lesions are hyper intense; found periventricularly, juxtacortical, infratentorial or spinal cord

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Dissemination in time

at least 2 lesions in locations typical for MS

14

Dissemination in space

either clinically or on
MRI: T2/Flair: hyperintense lesions with simultaneous enhancing lesions or see hyper intense lesions or enhancing lesions on F/U

15

Other diagnostic tools

-LP
-Evoked Potentials

16

MS on LP

-see oligoclonal bands in CSF: represents increased synthesis of ABs with limited # of responsible antigens in CSF
-also see IgG in CSF

17

MS Evoked Potentials

visual stimulation are presented and electrical impulse over primary visual cortex are recorded
-VEp will show increased latency suggesting signal thru optic nerve is slowed = optic neuritis

18

Types of MS

1) Benign
2) Relapsing-Remitting
3) Primary progressive
4) Secondary progressive
5) Progressive Relapsing

19

Relapsing-Remitting MS

-multiple episodes of transient neuro dysfxn which may or may not completely resolve
-But NO progressions btwn attacks = whatever disability had prior to attacks remains the same

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Primary Progressive

dz progresses relentlessly from onset
steady increase in disability w/out attacks

21

Secondary Progressive

pts with relapsing remitting start to have progression btwn attacks; usually occurs after 17 yrs

22

Progressive Relapsing

usually have relentless progression from onset but may have rare clinical relapses

23

Clinically Isolate MS

First attack of MS
-2 common clinically isolated syndromes: optic neuritis and transverse myelitis

24

Acute Relapse Tx of MS

IV methylprednisone
Plasma Exchange

25

Dz Modifying Tx;s

-Interferon Beta 1a: avonex, rabif
-Interferon Beta 1b: Betaseron, extavia
-Copaxone
**all have side effects

26

Second line Agents

Mitoxantone
Natalizumab

27

Oral Agents

Flingolimod
teriflunomide
dimethyl fumurate