Flashcards in Multiple Sclerosis 1 Deck (45)
How simply does Fingolimod work to treat MS?
It prevents T cell invasion of the CNS by trapping encirculating lymphocytes in peripheral lymph nodes
How does Fingolimod trap circulating lymphocytes in peripheral lymph nodes?
Fingolimod causes the internalisation of the receptor S1P1 (on the T cell)
This blocks the T cell from moving out of lymph nodes while sparing immune surveillance by circulating memory T cells
What are the 2 main side effects identified for Fingolimod?
1) 2 incidences of fatal herpes virus infection (type 1 encephalitis and disseminated zoster)
2) Bradychardia after 1st dose
What is the difference in relapse rate between Fingolimod and IM interferon 1a?
Fingolimod caused a 52% relapse reduction rate compared to IM interferon 1a
What are the 4 types of MS?
1) Relapsing -remitting MS - periods where symptoms flare up aggressively followed by periods of good or complete recovery
2) Secondary progressive MS - initially diagnosis of relapsing-remitting and over time frequency of relapses decreases but disability increases
3) Primary progressive MS - form in which disability increases from outset
4) Progressive relapsing MS - Disability increases from the outset but along the way have periods of relapse where symptoms flare up aggressively with remission but never full recovery
Although symptoms and inflammation can relapse and remit, what is the course of axonal loss in MS?
Gradual increase in axonal loss - straight line graph
What would brain imaging of someone with MS show over time?
What percentage of MS patients are confined to a wheelchair within 10 years of diagnosis?
What are the 2 main categories of treatment in MS?
1) Symptomatic treatments - management of the acute relapse (corticotherapy)
2) Modifying course treatments
What 7 things do symptomatic treatments for MS relapses aim to treat?
2) Mood problems
5) Sensory problems
6) Genitosphincteral problems
What is benign MS?
A version of relapsing-remitting MS with very mild attacks separated by long periods with no symptoms
What are the 7 potential targets for neuroprotective therapy in MS?
1) Inflammatory mechanisms
2) Excitotoxic mechanisms
3) Energy depletion
4) Genetic determination
5) Apoptotic mechanisms
6) Depletion of growth factors
7) Demyelination induced damage
Is MS treatable?
yes, but not curable
What are the 3 main current problems in MS management?
1) We don't know if treating the relapsing phase aggressively helps delay or prevent the progressive process
2) Still no effective treatment for progressive MS
3) There is no way of telling benign patients at the start of the disease