What is MS
Multiple
- affects spinal cord, optic nerve, and brain producing neurological symptoms
- no peripheral lesions
Sclerosis
- Plaques and scarring areas that make up the affecting lesions
Who is more affected men or women?
Which gender is more progressive
Women
Men = more progressive, appears later
Global distribution of MS
North America and Europe have high prevalences
In equatorial regions, no MS
What are non-genetic factors primarily responsible for (5)
- Vitamin D deficiency
- Epstein-Barr virus — greatest evidence among infectious agents
- Human Herpesvirus-6
- CMV
- Smoking
What is the risk of MS in geographical area for teens?
If you live in a HIGH RISK AREA for 2+ YEARS before the age of 15 –> you are more at risk of acquiring disease
What is the pathophysiology of MS (3)
- T cells release inflammatory cytokines (IL-23, IL-Y, TNF, osteopontin)
- Cytokines allow for B cells and macrophages to cross the BBB
- B cells produce antibodies leading to myelin destruction - T cells recognize proteins on myelin sheets as “foreign” and attack them –> causing demyelination
- Demyelination: SLOWS conduction of nerve impulses — may result in progressive, permanent loss of nerve function
- White matter in the brain is made up of myelin
When myelin is destroyed - you will therefore find lots of patches in the white matter
What is the MOA of an MS flare
When someone has an MS flare, we have an imbalance of pro-inflammatory and anti-inflammatory T cells –> promotes shift towards pro-inflammatory
What is a hallmark of MS (presence of what) (3)
High IgG synthesis in CSF
Bands of oligoclonal IgG
Clonal expansion of B-memory cells
T/F axons cannot be replaced hence the progressive loss of nerve functions
True
What are the types of MS (4)
Brief description of each
Clinically Isolated Syndrome (CIS)
- Resolves in 24h, may not progress to MS, no damage on scans
Relapsing MS (RMS)
- 85% of MS
Secondary Progressive (SPMS)
- progressed from RMS
Primary Progressive (PPMS)
- Progressive disease from diagnosis without remission
- 15%
- more resistant to treatment
T/F Patients can return to original baseline with treatment
False
- original baseline gets worse
What are characteristics of RMS (2)
Characterized by exacerbations lasting at least 24 hours + CNS inflammatory lesions
(will show during brain scans)
- Separated from other new sx by at least 30 days
- Followed by complete or incomplete remission
What is often the first symptom of MS
Optic neuritis/vision loss
MS motor symptoms (3)
- Gait problem
- Bladder spasticity and urinary retention
*Weakness/paralysis of limbs, trunk, head
MS Sensory symptoms (5)
- Often first symptom: Optic neuritis/vision loss
- Numbness/tingling
- Vertigo
- Hearing loss/tinnitus
- Neuropathic pain
MS Cerebellar symptoms (4)
- Ataxia (loss of control of body movement)
- Lack of speech coordination
- Dysphagia
*Sleep disorders
MS Emotional symptoms (3)
- Depression
- Psychological changes
*Suicidal rates: 7x higher
What are the secondary conditions that may result from MS symptoms. Give reason. (5)
- UTI or renal calculi from urinary retention
- Osteoporosis from steroid treatment of inflammation
- Respiratory infection from lack of respiratory function
- Poor nutrition from inability to swallow
- Decubitus (laying down) ulcers from lack of mobility
What are symptoms/syndromes strongly suggestive of MS (9)
*Acute urinary retention or incontinence
*Sexual dysfunction in males
*Lhermitte’s phenomenon
(Electric shock running down back into limbs with neck flexion)
*Acute optic neuritis — blurry vision, pain with eye movement
*Trigeminal neuralgia — sudden pain in eye or stabbing face pain
*Internuclear ophthalmoplegia
- Patients get nystagmus instead of looking left then right
*Temporary blindness or color blindness
*Bands of numbness/paresthesia
*Uhthoff’s phenomenon
When person feels sudden pain in heat
Relapse triggers (know this) (7)
- Infection
- Heat
- Sleep deprivation, stress
- Exertion
- Malnutrition, Anemia
T/F MS is a diagnosis of exclusion
True
T/F MS often starts with Clinically isolated syndrome (CIS)
True
What is the diagnostic criteria for asymptomatic patients (2)
If lesion is present in 2 or more sites
- Periventricular
- Cortical/juxtacortical
- Infratentorial
- Spinal cord
- Optic nerve
AND
one of the following:
- Dissemination in time
- CSF positivity
- Central vein positivity
MS Symptomatic relapse diagnosis (2)
If lesion is present in 2 or more sites
- Periventricular
- Cortical/juxtacortical
- Infratentorial
- Spinal cord
- Optic nerve
OR
You find a lesion in 1 site AND
- Patient has evidence of disease in CSF and central vein sign positivity
- Patient has evidence of disease in CSF and paramagnetic rim lesion positivity
- Patient has dissemination in time (DIT) and central vein sign positivity
- Patient has DIT and paramagnetic rim lesion positivity
