Multiple sclerosis

Question 1

Causes of MS (Aetiology)

Answer 1

• Auto immune disorder
• Demyelinating diseases
  -most common in countries further than the equator.

Question 2

Genes (Aetiology )

Answer 2

Genetic factors are unclear as over 100 genes can be responsible for MS.

Parent with MS = 1.5% chance

A brother or sister with MS = 2.7%

Question 3

Vitamin D (Aetiology)

Answer 3

• The further away from equator means
• less sunlight exposure
• VitD is produced in the skin on exposure to daylight
• MS patients have lower levels of VitD

Question 4

Pathology

Answer 4

-Immune mediated destruction of myelin
-characteristics plaques in the brain and spinal cord,predominantly in the white matter
- Random lesions around cerebral hemisphere

Question 5

Pathology of MS

Answer 5

-Immune response is triggered by unknown mechanism

Question 6

T cells

Answer 6

-T cells in peripheral immune system are activated (CD4 & CD8)
-T cells are myelin specific and autore active due to environmental and genetic factors
-They cross the blood-brain barrier (complex mechanism)
-T cells become reactivated by local CNS antigens (Macrophages, microglia or B cells)

Question 7

What do T cells secrete

Answer 7

• Secrete pro inflammatory cytokines
• plasma cells secrete antibodies against myelin

Question 8

Destruction of myelin sheath

Answer 8

-The cytokines and antibodies destroy the myelin sheath
-On going inflammation means microglia and triggered to secrete auto lyric chemicals
-This leads to further tissue damage and axonal loss

Question 9

Diagnosis

Answer 9

-Clinical history essential
-More than one episode of neurological symptoms required
-Often visual disturbances are reported first

Question 10

Diagnostic tests

Answer 10

Lumbar puncture looks for presence of proteins, oglioclonal bands and lymphocytes in CSSF
- Electrophoresis loos for the immunoglobulins in CSF (IgG)
-Evoked potentials visual looks at the auditory and somatosensory brain electrical activity.
MRI - Presence of inflammation and/or plaques

Question 11

Acute lesion

Answer 11

• Marked inflammatory raections

Question 12

Older lesions

Answer 12

-Infiltration with macrophages eventually leading to scarring

Question 13

Remyelination

Answer 13

Can occur following an acute inflammatory demyelinating episode

Question 14

Axonal damage

Answer 14

Observed during the acute inflammatory phase - (less researched)

Question 15

What does MS present as on an MRI

Answer 15

Presents as white matter atrophy.

Question 16

What is atrophy ?

Answer 16

Atrophy is the progressive degeneration or shrinkage of muscle or nerve tissue

Question 17

What are the two types of atrophy in MS?

Answer 17

Muscle atrophy and cerebral atrophy

Question 18

What is myelin sheath?

Answer 18

A layer of myelin surrounding the axons of some neurons.

Question 19

3 functions of MS

Answer 19

-Its fatty-protein coating provides protective insulation for your nerve cell, like the plastic insulation covering that encases the wires of an electrical cord.
-It allows the electrical impulses to travel quickly and efficiently between one nerve cell and the next.
-It maintains the strength of the impulse message as it travels down the axon.

Question 20

Types of MS

Answer 20

-Primary progressive
-Relapsing remitting
-Secondary progressive
-Progressive relapsing
-Benign

Question 21

Primary progressive

Answer 21

A form of the disease that is characterised from the beginning

Question 22

Relapsing remitting

Answer 22

Where a relapse happens and symptoms get wore followed by a recovery
Short duration (days to months)
Many remain symptom free for months or years
85% of females

Question 23

Secondary progressive

Answer 23

Stage of MS which comes after relapsing remitting
Slow steady progression
10% of females

Question 24

Progressive relapsing

Answer 24

Least common form of MS
Progressive worsening (decline form the beginning)
5% of females
Flare ups- with or without remissions- are also present

Question 25

Benign

Answer 25

A Version of relapsing remitting with very mild or no attacks separated by long periods with no symptoms.

Question 26

How is MS a clinically isolated syndrome?

Answer 26

• One off episodes of symptoms
• Can have further attacks and be diagnosed with MS
• Some people never go on to develop MS

Question 27

Clinical features of MS

Answer 27

• MS causes a wide range of symptoms
  -No definitive list of early signs and symptoms
• Every patient has a diff symptoms
  -Vague feeling of ill health over months or years
  -Visual symptoms are commonly reported initially.

Question 28

Signs and symptoms

Answer 28

Can occur at any stage of disease

-Visual problems (blurred vision, diplopia)
-Decreased balance
- Pain (neuropathic or musculoskeletal)
-Fatigue
-sensory disturbance
-muscle weakness
-Alteration in muscle tone
Cerebellar disturbance (ataxia- nystagmus and tremor)
-Gait disturbances

Question 29

Social impacts of MS on patients

Answer 29

-Accommodation and and living environment
-Family commitments - dependentnts,carer
-Financial implications if unable to work
-Relationships with family and friends
Hobbies
-Personal activities of daily living
-Activities of daily living
-Cooking,shopping,cleaning.

Question 30

Treatment options

Answer 30

• No cure for MS
  -Treatment consists of symptom management
  -Pharmacology
  -MDT approach
  -MS specialist nurses play central role
  -Focus on self management of a long term condition
  -Physio treatment will be developed further in PPN year 2

Question 31

MS Terms

Answer 31

-Sclerosis : means scarring
-Multiple: Relates to sites and types of scarring
-Rate of conduction of nerves is slowed down
-Chronic inflammation can result in atonal damage
-Symptoms seen are dependent upon which areas of the CNS is affected