Multiple sclerosis

Question 1

what is the leading cause of neurological disability in America?

Answer 1

MS

Question 2

is MS a demyelinating disease, an axonal disease, or both?

Answer 2

both

Question 3

is MS a disease of white matter, gray matter, or both?

Answer 3

both

Question 4

what is the peak age of onset for MS? what is the range?

Answer 4

33 (18-55)

Question 5

what virus is thought to be a trigger for MS?

Answer 5

EBV

Question 6

what is the only genetic factor of confirmed importance for MS? which chromosome?

Answer 6

HLA class two on chromosome 6

HLA-DRBI*1501

Question 7

what is the concordance rate of MS in monozygotic twins?

Answer 7

30%

Question 8

what represents the highest odds of getting MS?

Answer 8

if both parents have it - 35%

Question 9

what are the immunological features of MS?

Answer 9

• predominantly an aberrant T cell immune response
• activation of circulating CD4 cells specific for myelin basic protein, proteolipid protein, MOG and MAG
• dysfunction in the BBB allowing the activated cells to cross into the CNS attacking myelin

Question 10

what is the most important (and common) type of MS?

Answer 10

relapsing-remitting

Question 11

what are the poor prognostic indicators for MS clinical course?

Answer 11

• male
• older age at onset
• posterior fossa symptoms at onset
• AA
• significant residual disability from first attack

Question 12

focal findings in corpus callosum?

Answer 12

MS

Question 13

the presence of what CSF findings is suggestive of MS?

Answer 13

oligoclonal IgG bands

Question 14

what are characteristics of devic’s disease (neuromyelitis optica)?

Answer 14

• affects only optic nerves and cervical spinal cord
• blindness, quadriplegia
• spares brain parenchyma
• purely B cell mediated

Question 15

what is the pathophysiology of devic’s disease (neuromyelitis optica)?

Answer 15

affects aquaporin-4 channels

Question 16

what is acute disseminated encephalomyelitis (ADEM)?

Answer 16

• febrile illness
• pediatric more common than adult population
• typically involves gray and white matter of CNS
• typically monophasic (SINGLE lesion, not multiple)

Question 17

what is the role of ampryra in MS treatment? what is an adverse effect?

Answer 17

• improvement of gait
• speeds conduction time in demyelinated nerves
• seizures