Flashcards in MS Deck (32):
MS is caused my degradation of _____
How many MS patients are there in the US?
What latitude is at high risk of MS?
northern/ cool climates (possible vitamin D link)
Genetic risk assc with MS
20-40x risk if 1st degree relative has MS
Acute treatment of optic neuritis
1 gram IV prednisone 3-5 days
(for quicker improvement but no clear impact on longterm improvement)
What is needed to diagnose MS in the absence of symptoms?
-positive brain MRI
-positive spinal cord MRI
CSF findings in MS
1) oligoclonal banding
2) high IgG/ albumin ratio
3) high IgG synthesis
What are traditional (platform) agents for treating MS?
2) glatiramer (copaxone)
**No evidence to combine the two
**Medicaid prefers copaxone first
Disadvantages to traditional agents for MS?
2) incomplete efficacy
3) neutralizing Abs
What are three new MS oral therapies?
1) fingolimod (gilenya)
3) dimethyl fumarate (tecfidera)
-Most dangerous ADR
1) MC headache
2) dangerous: bradycardia, hypotension- first dose must be monitored
compatible with pregnancy?
- must be removed from system with cholestyramine if woman becomes pregnant
Common ADRs assc with Teriflunomide (auba-by-gio)
Dimethyl fumarate (tecfidera) common side effects
Natalizumab is the most effective drug for MS but is second line why?
1/1000 risk of PML
*can test patients for PML Ab to predict risk before starting drug (2% risk conversion)
Transverse myelitis: define
demyelination of the spinal cord
Variant of MS that fails to respond to DMARDs
Primary Progressive MS
NMO: location of lesions
spinal cord+ optic nerves
(loss of vision, loss of sensation, bladder dysfunction)
IgG against aquaporin 4 (chloride channel)
Rituximab (CD20 Ab)
Which is more severe: NMO or MS
Classic MRI finding in NMO
very long central necrotic region in cord MRI
NMO CSF findings
Is co-existing autoimmune disease more common in NMO or MS?
Treatment for spasticity
Treatment for neuropathic pain
1) amitryptiline (Elavil)
2) gabapentin (Neurontin)
3) pregabalin (lyrica)
4) carbamazepine (tegretol)
6) duloxetine (Cymbalta)
Cognitive domain usually spared in MS
language and verbal skills
What causes ^^ risk of cognitive dysfunction in MS
-large T2 lesion area
-large T1/2 lesion load
-greater number of juxtacortical lesions
What improves cognitive symptoms in MS?
stimulants, not alzheimers drugs
How is urinary retention treated in MS?