Multiple Sclerosis Flashcards by Taylor Smith

What is multiple sclerosis (MS)?

A chronic immune-mediated inflammatory disease causing CNS demyelination and degeneration

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Primary pathology of MS

Loss of myelin sheath in CNS with scarring (gliosis) and axonal loss

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Key features of MS

Inflammation; demyelination; plaque formation; gliosis

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Where does MS primarily occur?

White and gray matter of brain and spinal cord

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What are MS plaques?

Areas of scar tissue from demyelination

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What is gliosis?

Scarring from glial cell activity in CNS

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Function of myelin sheath

Allows rapid nerve signal transmission

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Effect of demyelination

Slows or blocks nerve impulse transmission

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Ultimate effect of MS progression

Neuron death and brain atrophy

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Comparison disease (PNS demyelination)

Guillain-Barré syndrome

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Etiology of MS

Unknown; likely genetic + immune + environmental trigger

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Common trigger theory for MS

Infection activating immune system

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Typical age of onset

20–40 years

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Sex prevalence

More common in females

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MS severity in males

Often more severe and progressive

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Geographic risk factor

Higher prevalence in cooler climates (northern regions)

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Latitude association

Higher above and below 40th parallels

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Ethnic risk factor

More common in White individuals

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Family history risk

Increases likelihood of MS

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Other possible risk factors

Smoking; vitamin D deficiency; obesity; infections

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Immune cells involved in MS

T lymphocytes and antibodies

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Pathophysiology step 1

T cells cross blood-brain barrier

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Step 2 of MS pathophysiology

Inflammation increases; myelin breakdown begins

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Step 3 of MS pathophysiology

Antigen-antibody reaction attacks myelin

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Step 4 of MS pathophysiology

Loss of oligodendrocytes (myelin-producing cells)

Step 5 of MS pathophysiology

Demyelination and plaque formation

Step 6 of MS pathophysiology

Axonal damage and death

Result of myelin destruction

Delayed then lost nerve signals

Early MS nerve changes

Inflammation with preserved signal transmission

Intermediate MS changes

Myelin detachment and axon damage

Late MS changes

Complete signal blockage and permanent function loss

Why MS diagnosis is often delayed

Early symptoms are mild and insidious

General pattern of MS symptoms

Depend on which nerves are affected

What are exacerbations (relapses)?

Temporary worsening of symptoms

Duration of relapses

Days to weeks

Goal of MS treatment

Reduce relapse frequency and severity; slow progression

Benign MS course

Relapse followed by full return to baseline

Relapsing-remitting MS (RRMS)

Most common; periods of relapse and remission

RRMS prevalence

80–90% of MS cases

RRMS recovery pattern

Partial recovery with slight decline over time

Primary progressive MS (PPMS)

Steady worsening without relapses/remission

Secondary progressive MS (SPMS)

Starts RRMS → becomes progressive

Progressive relapsing MS (PRMS)

Progressive disease with occasional relapses

Key factor in MS classification

Frequency of relapses and duration of remission

Common initial MS symptom

Paresthesia (numbness/tingling)

Other early MS symptoms

Weakness; vision problems; gait issues

Example of nerve-specific symptom

Optic neuritis causing unilateral vision loss

Bladder-related MS symptoms

Incontinence or urinary retention

Cognitive symptom of MS

"Cog fog" (difficulty thinking/concentrating)

Difference between cog fog and memory loss

Not memory loss but impaired thinking clarity

Common psychological symptom

Depression

Cause of depression in MS

Loss of function and disease burden

Common physical symptom

Fatigue

Pain types in MS

Chronic or acute (burning or stabbing)

Bowel dysfunction in MS

Constipation or incontinence

Mobility issues in MS

Balance problems; gait disturbance; fall risk

Advanced mobility impairment

May require wheelchair

Sexual dysfunction in MS

Possible due to nerve involvement

Vertigo in MS

Can occur due to CNS involvement

Main pharmacotherapy goals

Slow disability; reduce relapses; extend remission; reduce lesions

Types of MS treatments

Disease-modifying; relapse treatment; symptom management

Interferon beta example

Avonex

Mechanism of interferons

Prevent pro-inflammatory cells crossing BBB

Effectiveness of interferons

Reduce relapse rate by ~30%

Interferon adverse effects

Flu-like symptoms; liver toxicity; bone marrow suppression; depression

Glatiramer acetate (Copaxone) mechanism

Increases anti-inflammatory T cells

Glatiramer adverse effects

Injection reactions; flushing; chest pain; palpitations; rash; laryngeal constriction

Duration of glatiramer reaction

Usually transient (10–20 minutes)

Fingolimod mechanism

Traps lymphocytes in lymph nodes

Use of fingolimod

Common in RRMS

Dimethyl fumarate mechanism

Suppresses immune cells; reduces inflammation

Natalizumab mechanism

Prevents T cells from crossing BBB

Natalizumab effectiveness

Reduces relapse rate by ~68%

Natalizumab major risk

Progressive multifocal leukoencephalopathy (PML)

Natalizumab program

TOUCH prescribing program required

Natalizumab adverse effects

Headache; fatigue; liver toxicity; hypersensitivity

Risk factor for PML

Use with other immunosuppressants

Natalizumab use

Monotherapy for RRMS

Alemtuzumab use

Reserved for poor response to ≥2 therapies

Mitoxantrone use

SPMS; PRMS; worsening RRMS

Treatment for acute MS relapse

High-dose IV glucocorticoids (pulse therapy)

Typical steroid dose

500 mg–1 g daily for 3–5 days

Steroid complications

Hyperglycemia; requires monitoring

Alternative relapse treatment

IV immunoglobulin (IVIG)

ACTH gel use

For relapse if steroids ineffective/intolerable

Plasmapheresis use

Removes plasma and replaces with donor plasma

Purpose of plasmapheresis

Remove harmful immune components

Symptom management approach

Individualized based on presentation

Urinary symptom treatment

Anticholinergic (frequency); cholinergic (retention)

Constipation management

Hydration; fiber; bulk laxatives

Fatigue treatment

Amantadine; rest planning

Muscle spasm treatment

Muscle relaxants

Cognitive symptom treatment

Donepezil (Aricept)

Multiple Sclerosis Flashcards

(93 cards)