Multiple Sclerosis

Question 1

Multiple Sclerosis (MS)

Answer 1

Progressive disorder (worse and worse across lifespan) that primarily attacks the myelin of axons in the CNS, but there is also cell loss (glial scarring in the brain)

Often appears to attack the CNS myelin as if it were a foreign substance

Question 2

Scanning MS

Answer 2

Bright spots is where cells have died when you go scan brain
Doesn’t mean that action potential becomes slower but it decays while travelling→ sensory info doesn’t reach brain→ loss of sensation
Action potential in motor axons→ loss of motor coordination→ spasms

Question 3

Common Symptoms in advanced cases of MS

Answer 3

visual disturbances, muscular weakness, numbness, tremor, and loss of motor coordination.

Question 4

Theories of Pathogenesis

Answer 4

1. Primarily an autoimmune disease (“outside-in” theory).
2. Primarily a neurodegenerative disease, with inflammation in
   some patients (“inside-out” theory).

Question 5

What are the forms of MS?

Answer 5

1. relapsing-remitting
2. secondary progressive
3. primary progressive

Question 6

Life expectancy of those with MS

Answer 6

5-10 years

Question 7

Relapsing-remitting

Answer 7

• periods of being symptomatic and periods where you aren’t
• remit faster and faster each time

Question 8

Secondary progressive

Question 9

Primary progressive

Question 10

What are evidences that show MS is not an autoimmune disorder?

Answer 10

1. If you block immune system, you should block progression of disease but that’s not the case (only helps with reducing symptoms)
2. Some individuals with MS don’t really have a strong inflammatory response, varying levels of response
3. If it is an autoimmune disorder, expect that cells would attack outside cells of myelin but it is the innermost that seems dysfunctional first; innermost parts are not reachable by innermost cells (hence, it’s not autoimmune)

Question 11

Geography of MS

Answer 11

North south gradient- further you move away from equator, higher prevalence of MS (Canada has higher levels of MS)

Linked to exposure of Vitamin D- we have low exposure levels

Question 12

Does genetics play a role in MS?

Answer 12

Even with no one in the family have MS, there’s still a 65-70% chance to get it, strong effect of environmental influences

Question 13

Treatment or prevention for MS

Answer 13

1. Vitamin D- preventative, not treatment
2. Corticosteroids
3. Immune system modulators- 3 & 4- suppress immune system→ suppress from attacking own cells but they don’t stop progression; can’t live on these things (can affect bone density)
4. Cannabis (Sativex) - why cannabis was medicalized, help for muscle spasticity
5. Physical therapy
6. Muscle relaxants
7. High-dose biotin? (Modest) - clinical trials, only little effects but better than none
8. Hematopoietic stem cell transplantation? (Maybe) - wipe out someone’s immune system and rebuild using stem cells
9. Hopefully EBV vaccine soon (not treatment, though)

“Liberation treatment” of the veins? (No, doesn’t work)