Flashcards in Multiple Sclerosis 1 Deck (45)
What is optic neuritis?
Inflammation of the optic nerve
What are the main symptoms of optic neuritis? 2
Pain and loss of vision
Can optic neuritis be visualised using fundoscopy?
No, it is frequently not visible as it is retro bulbar
What is the prognosis of optic neuritis, what percentage return to visual acuity within 6/12?
What is the treatment for optic neuritis, does this effect final acuity?
High dose steroids - these speed up recovery but have no effect on final acuity
What percentage of people who have suffered from optic neuritis go on to develop MS within 10 years?
What is transverse myelitis?
Inflammation inside the spinal cord
What is Lhermitte's sign/phenomenon?
Sudden sensation resembling an electric shock which passes down the back of the neck and onto the spine and may radiate into the arms and legs, usually triggered by bending your head forward towards your chest
Is transverse myelitis normally severe? What is the prognosis?
Normally mild, with a good prognosis
What are the 3 main symptoms of transverse myelitis?
1) Often purely sensory symptoms
2) Lhermitte's sign
3) May affect the bladder
What percentage of people with transverse myelitis go on to develop MS?
Is MS mainly a clinical or imaging diagnosis?
Mainly a clinical diagnosis
What criteria can be used for diagnosing MS?
Macdonald criteria 2010 (2nd revision)
In what situation could you diagnose clinically definite MS?
Optic neuritis and transverse myelitis at different times
In which 4 situations is a clinical diagnosis of MS not definite?
1) Clinically isolated syndrome (CIS)
2) Myelitis and optic neuritis at the same time
3) Recurrent myelitis
4) Recurrent or sequential optic neuritis
What is the most common cause of neurological disability in young people?
Is MS more common in females or males?
What is the most common age of onset of MS?
In which ethnicity is susceptibility to MS highest?
Northern Europeans, US Caucasians, Canadians
Prevelance of MS is strongly dependent on latitude, which factors can this be attributed to?
Environmental factors such as habitat, diet and infections
MS is a disease of which body system?
What is MS?
Autoimmune disease - inflammatory reaction in the CNS which causes loss of myelin and slowing of nerve conduction. Get areas of demyelination and loss of axons
Give 2 possible mechanisms of demyelination in MS?
1) immune mediated - macrophages destroy myelin
2) Antibody mediated destruction of myelin
Give 9 disease modifying treatments used in MS?
1) Interferon beta 1-b
2) Interferon beta 1-a
3) Glatiramer acetate
5) Dimethyl fumarate
How does interferon beta treatment reduce the number of relapses in MS and when is it most effective?
1) Reduces the number of relapses by 1/3
2) Effective early in the disease course - no evidence on long term effect on disability
TYSABRI (Natalizumab) is the first humanized mAb approved for the treatment of MS, how is it thought to work?
It inhibits adhesion molecules on the surface of immune cells, its is thought to work by preventing immune cells from migrating into the bloodstream and into the brain where they can cause inflammation and potentially damage nerve fibres and their insulation
Which molecules on the activated leucocyte and the BBB are the key components involved in immune cell adhesion and migration?
1) Activated leucocyte - a4-integrin
2) BBB - VCAM-1
Which molecule on the activated leucocyte is blocked by Natalizumab?
a4-integrin - prevent it interacting with VCAM-1 on the BBB
Name 3 new oral treatments for MS?
3) Dimethyl fumarate