Multiple Sclerosis Flashcards
what type of disorder is MS
a chronic, inflammatory demyelinating disorder
age of diagnosis for MS
15-45 yo, peak incidence 4th decade
which gender more commonly has MS
women
factors that may be linked to MS
genetic: MS susceptibility genes (HLA class II)
environmental: late onset/severe childhood infections, viral infections
what might be a protective factor for MS
increased vitamin D
describe the pathophysiology of MS
auto-reactive T-lymphocytes are activated, cross into the CNS, and attack the myelin sheath of neurons— damaged myelin forms scar tissue (sclerosis)
T cells induce pro-inflammatory response in which cytokines further activate B cells/macrophages
what is the role of the myelin sheath?
a fatty substance surrounding and insulating neurons, necessary for proper signal transduction in CNS
what are PRIMARY MS symptoms?
visual complaints, gait problems, paresthesias, pain, spasticity, weakness, ataxia, speech difficulty, psychological changes, cognitive changes, fatigue, bowel/bladder dysfunction, sexual dysfunction, tremor
what is the relationship of heat sensitivity and MS
many people with MS experience worsening of symptoms with increased body temperature: cooling may help (cooling vests, etc)
what are secondary and tertiary MS symptoms
secondary: recurrent UTI, urinary calculi, decubiti, muscle contractures, resp infections, poor nutrition
tertiary: financial problems, personal/social problems, vocational problems, emotional problems
4 different subtypes of MS
relapsing-remitting: relapses with full recovery
secondary progressive: (following relapsing-remitting) disease progresses with or without occasional relapses/remissions/plateaus
primary progressive: progressive from onset
progressive relapsing: progressive from onset with acute relapses– with or without full recovery– continuous progression between relapses
what factors indicate a favorable prognosis in MS?
<40 years at onset
female
initial symptoms: optic neuritis or sensory symptoms
low attack frequency in early disease
relapsing/remitting course of disease
which factors indicate an unfavorable prognosis in MS?
> 40 years at onset
male
motor or cerebellar initial symptoms
high attack frequency in early disease
progressive course of disease
diagnosis/assessment of MS?
MRI: demyelination present
CSF: CNS IgG is increased, serum IgG normal
Oligoclonal bands (OCBs) are present
CEDSS: expanded disability status scale
3 broad treatment categories for MS
treatment of acute attacks
disease-modifying therapies
symptomatic therapy
how are acute exacerbations treated in MS
methylprednisolone 500-1000 mg/day IV x 3-5 days
which disease modifying therapies are PO
teriflunomide
dimethyl fumarate
diroximel fumarate
fingolimod
siponimod
cladribine
which disease modifying therapies are INJECTABLES (SQ)
interferon beta
glatiramer
ofatumumab
which disease modifying therapies are INFUSIONS (IV)
alemtuzumab
mitoxantrone
natalizumab
ocrelizumab
teriflunomide brand name
aubagio
dimethyl fumarate brand name
tecfidera
diroximel fumarate brand name
vumerity
fingolimod brand name
gilenya
siponimod brand name
mayzent
