MS

Question 1

Etiology & patho of MS

Answer 1

• a chornic inflammatory autoimmune disease that affects the CNS
• lesions are: autoimmune inflammation and demyleination resulting in axonal loss of mylein
• MC: relapsing/remitting type: wehre symptoms tend to come and go
• affects women > men

main etiology: revolves around understanding there is a chronic inflammatory proccess which results in autoimmune demyleination of teh axons in the CNS

• genetic susceptibility: MHC molecule inflammation: some people more susceptible – HLA_DR2
• some environmental tirggers (lack of VIT D and sunlight is a big one!)

Patho
- T-cells triggerer:cross BBB and cause destruction in the CNS: attack the mylein : white matter attacked (brain and SC)
- when the mylein is lost: you have decrease in the function of the neruons and ability to fire
- get results which are motor, sensory and visaul impairments

Question 2

Symptoms of MS

SIgns

Answer 2

• primary presentation optic neuritis and sensory dysfunction (increased or decreased) +/- motor dysfunctions

Commonly
- sensory (pain, parasthesias)
- then weakness & visual disturbances (optic neuritits & diplopia)
- trigeminal neuralgia

Others
- cognitive impairment: memory, attention
- baldder, bowel and sexual dysfunction (think SC)
- fatigue (very common)
- depression

Signs
- CN dysfunction; optice neuritis, INO (lesions eyes dont do the same thing), diplopia, trigem nerualiga
- umn lesions: hyperreflexia
- cerebellar dysfunction: gait ataxia, slurred speech

Question 3

MS Diagnosis

Answer 3

Diagnosis
- made from objective evidence of dissemination in time and spcace of the typical MS lesions
- evidence of clincial symptoms
- MRI with contrast : to see MULTIPLE (at least 2) lesions: white plaques in teh brain on MRI
- LP: to see inflammation in the CSF: CSF antibody levels and see IGg and Oligoclonal bonading
- can do evoked potentails to see brain response

Question 4

MS Treatment

Answer 4

overtime, those with MS have progressive worsening of the diease and leads to brain atrophy of the white matter

Late Findings
- chronic demyleination & perimnent axonal loss and atrophy

for treatemnt:the progresison of the disease is variable and consistns of relapse, revoery and progression

SOme pts: relapse/remitting type
some pts: progression (just alwasy worsening)

thus: earlier treatment = better outcomes

Acute Exacerbations: high dose steroids IV glucocorticoids

Long Term treatmetn:
first line: interferons (beta?)
rituxamab can be used as it is most effective to reduce lesions on MRi