Lecture 13: Multiple Sclerosis

Question 1

MS

Answer 1

• Autoimmune demylinating disorder

- Elapsing episodes of immunologically mediated demyelination and the lesions are separated in time and space

Question 2

Prevalence

Answer 2

• 20-40 diagnosis
• 1M:2F
• 85% have relapsing remitting
• 15% have progressive pattern

Question 3

Pathogenesis

Answer 3

• T cell mediated inflammatory diseases
• CD4+ T cells are react against self myelin antigens
  -> activation of microglia and macrophages
  -> mg and mp and their injurious products cause
  demyelination
• Clinical symptoms are due to myelin loss effect in electrical transmission along axons

Question 4

Remyelination

Answer 4

• remyelination can take place but this works best in the early stages of the disease
• some complete remyelination of MS lesions of patients with early MS (40-50% of cases)
• patients with chronic MS lesions only show complete remyelination of lesions in about 10-15% of cases

Question 5

Aetiology

Answer 5

• Cause unknown
• Likely to be an interaction of several diff factors:
• immunology
• infectious agents
• epidemiology
• environment: Vit D deficiency
• genetic
  likely to be the result of a genetic susceptibility which predisposes to an inappropriate immune response to viral infections

Question 6

5 major health problems

Answer 6

1. motor control: muscular spasms and problems with weakness, coordination, balance
2. fatigue
3. other neurological symptoms: vertigo, pins and needs, neuralgia, visual disturbances (optic neuritis)
4. continence problems
5. Neuropsychological symptoms: memory loss, depression, cognitive difficulties

Question 7

Diagnosis

Answer 7

• MRI: detecting brain lesions (plaques)

- CSF: elevated IgG levels and oligoclonal bands

Question 8

Attacks

Answer 8

• acute onset over a few days
• increasing symptoms over a week
• few weeks without change
• gradual recovery over a couple of months

Question 9

Macroscopically

Answer 9

• Plaques in brain and SC
• Usually at least 12 plaques
• Active lesions and old lesions
• generally a correlation between location of lesions and clinical symptoms