MS

Question 1

into to Multiple sclerosis

Answer 1

• Central nervous system disorder
  
  • demyelinating and axonal disease
• affects white matter predominantly, but also affects grey matter
• autoimmune disease (not classicly autoimmune, more autoimmune mediated)

Question 2

epidemiology of MS

Answer 2

• Geographical variation (incidence increase with increasing latitude)
• More likly in females (2-3:1)
• peak age of onset is about 30 (typically 18-55)

Question 3

genetics of MS

Answer 3

• predominantly a disease of caucasians
• polygenic disease
  
  • HLA class II regions
• High concordance rate of 30% in monozygotic twins

Question 4

immunology of MS

Answer 4

• predominatly an aberrant T-cell immune response (B-cells and macrophages play increasingly important role
• Activation of circualting CD4 cells sppecific for myelin basic protein, proteolipid protein, MOG and MAG
• Dysfunction in the BBB allowing the activated cells to cross in the CNS attacking myelin

Question 5

what are the poor prognostic indicators of MS

Answer 5

• male
• older age at onset
• posterior fossa symptoms at onset
• african-american
• significant residual disability from first attack

Question 6

Diagnosis of MS

Answer 6

• HISTORY!!!!!
  
  • age, race, gender, rearing
• Neurlogical exam
  
  • signs referable to CNS (extensor plantar responses, clonus, optic disk, etc)
• MRI scans!!!
  
  • lesions in corpus collosum!!!
• Cerebrospinal fluid exam
  
  • OLIGOCLONAL IgG BANDS
  • elevated IgG synthesis rate
• Evoked Potentials
  
  • VER most helpful

Question 7

Neuromyelitis Optica (NMO) or Devic’s disease

Answer 7

• B-Cell MEDIATED DISEASE
  
  • targets Aquaporin-4 ab (NMO-IgG)
• tranvserse myelitis and often bilateral O.N.
• Initial cranial MRI often normal
• Longitutinally extensive spinal lesions

Question 8

Acute disseminated encephalomyelitis (ADEM)

Answer 8

• Febrile illness
  
  • fever, confusion, seizures
• pediatric > adult pop
• Typically involves grey and white matter of CNS
• TYPICALLY MONOPHASIC

Question 9

Ampryra

Answer 9

• showed improvement in GAIT based on 25 foot timed walk. MAY REDUCE MOTOR FATIGUE
• Sustained release prep is well tolerated

Question 10

Vitamin D

Answer 10

• osteoporosis/osteopenia are under-diagnosed and under-traeted in MS
  
  • treatment with calcium/vit D is recommended
• animal model showed less severe disease course when treated with vitamin D

Question 11

Disease directed tx of MS

Answer 11

• Immunomodulation
  
  • inferferons