Multiple Sclerosis

Question 1

Who is most affected by multiple sclerosis?

Answer 1

• young women (incidence is twice as high in women)

also:

• white people
• people in colder regions

Question 2

When does the onset of multiple sclerosis normally occur?

Answer 2

between 20 and 40 years

Question 3

What is the etiology of MS?

Answer 3

• unclear
• seems to be complex trait
• has a familial tendency (risk increases 50 times if you have a first degree relative with MS)
• genetic susceptibility (MHC/HLA)
• may have a viral trigger

Question 4

What type of problem is MS?

Answer 4

It is an autoimmunity problem.

Question 5

What are the manifestations of MS?

Answer 5

vary, come in pattern of exacerbation and remission:

• visual impairment
• paraesthesia
• fatigue
• bowel and bladder dysfunction
• decreased muscle strength
• gait and coordination problems

Question 6

How is MS diagnosed?

Answer 6

• history and presentation
• plaques CAN be seen via MRI
• labs to rule out other conditions
• analyze CSF (look for proteins = antibodies)

Question 7

What do proteins in CSF generally indicate?

Answer 7

1) damaged BBB
2) autoimmunity
3) inflammation

Question 8

What areas are often targeted?

Answer 8

• optic nerve
• cerebellum
• spinal cord

Question 9

What happens in MS? What is the pathophysiology?

Answer 9

• autoimmunity causes irregular targeting of oligodendrocytes and the myelin sheath in the CNS only
• inflammation follows the targeting and can damage cells further, can cause infiltration of lymphocytes and macrophages
• cells are damaged and there is necrosis of oligodendrocytes
• causes demyelination in the brain and spinal cord
• damaged areas = plaques/sclerotic patches and have conduction problems
• conduction problem can mean muscles are not stimulated… disuse can lead to atrophy

Question 10

How is MS treated?

Answer 10

• steroids for inflammation (use for acute relapses)
• methotrexate (an anticancer drug that is immunoregulatory, will need to give folic acid too)
• interferon for persistant relapses (an antiviral with immunomodulatory and anti-inflammatory properties)
• treat the symptoms