Multiple Sclerosis Flashcards
What is MS?
inflammatory demyelinating disorder of the CNS, is it caused by an autoimmune reaction against myelin
What is the epidemiology of MS?
females > males
occurs around 30s or 40s
first degree relative with MS = 12% chance you’ll get it
identical twin with MS = 33% chance you’ll get it
What are the risk factors of MS?
vit D déficiency
Epstein Barr Virus
living far away from the equator
What is the presentation of MS?
pyramidal dysfunction: increased tone, spasticity, weakness of extensors of upper limbs and flexors of lower limbs
lower urinary tract dysfunction
optic neuritis
intranuclear opthalmoplegia - failure of adduction and nystagmus in the abducting eye with lag in the other
fatigue
What is the pathology behind MS?
plaques in the brain - show irregular, glassy appearance
What are the two types of plaques in MS?
active
inactive
Describe active plaques in MS?
perivascular inflammatory cells
ongoing demyelination and presence of microglia
demyelinating plaques are yellow/brown with an ill defined edge
Describe inactive plaques in MS?
gliosis
little remaining myelinated axons and oligodendrocytes
well demarcated gray lesions in white matter
Where do plaques commonly occur in MS?
brainstem corpus collosum spinal cord cerebellum optic nerves and chiasm adjacent to lateral ventricles
What is the pathogenesis behind MS? genes?
genes = HLA DRB
lymphocytic infiltration in histology
Th1 cells and Th17 cells do the damage
oligoclonal IgG bands in CSF
How is MS diagnosed?
a least two episodes suggestive of demyelination - in different places at different times
What is the first line investigation of MS?
MRI - lesions in white matter
What are other investigations of MS?
lumbar puncture - oligoclonal bands in CSF
neurophysiology
What is the management of an acute exacerbation/relapse?
mild - symptomatic treatment
moderate - oral steroids - methylprednisolone
severe - admit and give IV steroids
What is the 1st line disease modifying drug for MS?
Tecfidera
When would you give a 1st line DMD for MS?
2 moderate relapses in 2 years
What is the 2nd line DMD for MS?
Tysabri and Ocreus - monoclonal antibody
When would you give a 2nd line DMD for MS?
relapse after 1st line or really bad presentation
What are 3rd line therapies for MS?
HSCT - stem cell transplant
Mitroxantrone or Lemtrada
What is the role of Tysabri?
causes leukocyte apoptosis
but can cause PML in those with the JC virus - be careful
What are the 4 possible pathways of MS?
relapsing remitting
secondary progressive (can turn into progressive relapsing)
primary progressive
progressive relapsing
What is PML?
progressive multifocal leukaenceohalopathy - brain infection that may kill you
