Multiple Sclerosis

Question 1

What is optic neuritis?

Answer 1

• Inflammation of optic nerve
• Pain & loss of vision
• High dose steroids speed recovery
• 50% develop MS within 10 years

Question 2

What is transverse myelitis?

Answer 2

• Inflammation inside spinal cord
• Mild with good prognosis
• Pure sensory
• May affect bladder
• Lhermittes phenomenon
• 50% develop MS

Question 3

What is MS?

Answer 3

• CNS disease
• Inflammatory reaction in CNS= loss of myelin & slowing nerve conduction
• Areas of demyelination
• Loss of axons

Question 4

What are the disease modifying treatments for MS?

Answer 4

• Interferon beta1-b/1-a (effective early treatment)
• Glat acetate
• Dimethyl Fumarate (oral)
• Natalizumab/Tysabri
• Fingolimod (oral from fungus)

Question 5

How does Tysabri work?

Answer 5

• Monoclonal antibody
• Inhibits adhesion molecules on surface of immune cells (integrin-4)
• Prevents immune cells migrating from bloodstream into the brain
• Stops damage to nerve fibres & insulation

Question 6

What is the mechanism of action of Fingolimod?

Answer 6

• Internalises S1P1 receptor on T cells
• Blocks lymphocyte progress but spares immune surveillance
• Reduces neuroinflammation

Question 7

What are symptomatic problems of MS?

Answer 7

• Fatigue
• Mood problems
• Pain
• Sensory problems
• Tremor
• Spasticity
• Genitosphincteral problems

Question 8

What are the potential targets for neuroprotection?

Answer 8

• Inflammatory
• Excitotoxic
• Energy depletion
• Apoptotic
• Genetic determination
• Depletion of growth factors
• Demyelination