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Flashcards in Symposium 6: Multiple Sclerosis Deck (41):

What is optic neuritis?

Inflammation of the optic nerve


What are the symptoms of optic neuritis?

Causes pain and loss of vision


Why is the neuritis frequently not visible?

It's retrobulbar


What is the prognosis for optic neuritis?

Good prognosis: 95% return to visual acuity of 6/12 or greater within 12 months


What treatment speeds up the recovery of optic neuritis?

High dose steroids speed up rate of recovery but have no effect on final acuity


What percentage of people with optic neuritis go on top develop MS within 10 years?



What is transverse myelitis?

Inflammation inside the spinal cord


What are the symptoms of transverse myelitis?

- Inflammation inside the spinal chord
- Often mild with good prognosis
- Often pure sensory
- Lhermittes phenomenon - sudden sensation of electric shock
- May affect bladder


What percentage of people with transverse myelitis go on to develop MS?



What is required for clinically definitive MS?

- Optic neuritis and transverse myelitis at different times


What is not definitive MS?

- Clinically isolated syndrome (CIS)
- Myelitis and optic neuritis at the same time
- Recurrent myelitis
- Recurrent or sequential optic neuritis


In what sex is MS more common?



What is MS?

- MS is a disease of the central nervous system (CNS)
- An inflammatory reaction in the CNS causes loss of myelin and slowing of nerve conduction
- Areas of demyelination
- Loss of axons


What are the possible mechanisms of demylination?

- CD8+ mediated inflammation
- Macrophage-mediated inflammation
- Autoantibodies


What are the diseas-modifying treatments for MS?

- Interferon beta 1-b
- Interferon beta 1-a
- Glatiramer acetate
- Teriflunamide
- Dimethyl Fumarate
- Fingolimod
- Natalizumab (Tysabri)
- Alemtuzumab (Lemtrada)
- Mitoxantrone


How useful is Inferferon beta?

- Reduces the number of relapses by a third
- Effective early in the disease course
- No evidence on long-term effect on disability


What is the mechanism of action for tysabri?

Inhibits adhesion molecules on the surface of immune cells. Research suggests TYSABRI works by preventing immune cells from migrating from the bloodstream into the brain where they can cause inflammation and potentially damage nerve fibers and their insulation.


What is the mechanism of action for Natalizumab?

- The interaction of the adhesion molecules, alpha4-integrin on the activated leukocyte with VCAM-1 on the blood-brain barrier are the key components involved in immune cell adhesion and migration.

- Natalizumab is the first in a class of SAM inhibitors that prevent the migration of immune cells across the blood-brain barrier by selectively attaching to alpha4-integrin.


What are the oral treatment options for MS?

- Fingolimod
- Teriflunomide
- Dimethyl Fumarate


How does fingolimod work?

It reversibly sequesters lymphocytes away from blood and susceptible target organs such as the CNS, thereby reducing neuroinflammation in MS.

It's a promising agent that is the prototype of a new class of drugs that interact with the sphingosine-1-phosphate (S1P) receptor, which is found on T cells and many cells within the CNS.


What are the types of disease progression seen in MS?

- Relasping-remitting
- Primary progressive
- Secondary progressive
- Progressive relapsing


What are the common symptoms of MS?

Mood problems
Sensory problems
Genitosphincteral problems


What are the targets for neuroprotection?

- Inflammatory mechanisms (NOS, CD8, TNF etc)
- Excitotoxic mechanisms (glutamate overactivation)
- Demylination
- Energy depletion (mitochondrial dysfunction, free radicals)
- Genetic determination
- Apoptotic mechanisms
- Depletion of growth factors


What is spinal cord injury?

A spinal cord injury is a disruption to the spinal cord
(usually due to trauma)


What is a cauda equina injury?

A cauda equina injury is a disruption to the nerve roots that lie with in the spinal column


What is the epidemiology of spinal cord injury?

- 10 to 15 new cases per million population per year (incidence)
- 40,000 people living with spinal cord injury in the UK (prevalence)

- Males 4:1 Females

- Age: bimodal distribution


What are the common congenital causes of spinal cord injury?

- Spina bifida
- Congenital spinal abnormality
- Spinal muscular atrophy
- Birth trauma


What are the possible acquired causes of spinal cord injury?

- Trauma
- Infection
- Inflammatory
- Tumour
- Vascular
- Metabolic
- Degenerative
- Idiopathic
- Iatrogenic


What are the most common acquired causes of spinal cord injury?

Trauma (vehicles)
Bacterial infection
Secondary tumour


What level spinal lesions cause tetraplegia?

C1 to T1


What level spinal lesions cause paraplegia?

T2 to L5


What kind of examination would you perform for a spinal cord injury record.

- Manual muscle testing
- Sensory testing for light touch and pinprick sensations


What is the AISA impairment scale?

A (Complete)
No motor or sensory function is preserved in S5

B (Incomplete)
Sensory but not motor function is preserved below the neurological level to S5

C (Incomplete)
Motor function preserved, and more than half of key muscles below the neurological level have a muscle grade less than 3

D (Incomplete)
Motor function preserved, and at least half of key muscles below the neurological level have a muscle grade of 3 or more


What are the names of the descending motor tracts?

- Lateral corticospinal
- Anterior corticospinal


What are the names of the ascending sensory tracts?

- Dorsal columns
- Anterolateral spinothalamic
- Spinocerebellar


What is spinal shock?

- Excessive vagal stimulation
- Lesions above T6
- Loss of parasympathetic control
- Bradycardia
- Asystole
- Prevent by avoiding vagal stimulation
- Atropine prior to intubation, suctioning


What is autonomic dysreflexia?

Lesions above T6 in established patients
Precipitated by
- Bladder distension, constipation
- Skin, soft tissue, bony injuries
Presents with headache, hypertension, facial flushing
- Relieve cause, antihypertensives


What are the acute complications of spinal cord injury?

Urinary tract infections
- Urinary tract stones
- Progressing to renal failure
Respiratory infection
- Progressing to respiratory failure
Pressure sores
- Osteomyelitis, amyloid, neoplastic change


What is the management of acute spinal cord injury?

- Bed rest/positioning/skull traction
- Prevent further damage to spinal cord
- Skin care
- Bladder and bowel care
- Prevention of thromboembolic and GI complications


What is the management of chronic spinal cord injury?

- Appropriate skin care
- Bladder and bowel care
- Prevention of thromboembolic complications
- Different presentations
e.g. acute abdomen


What are the chronic complications of spinal cord injuries?

Progressive neurological decline
- Syringomyelia
- Neuronal “drop-out”
- Pain and spasticity
Rheumatological complications
- Degenerative joint disease
- Hetertopic ossification