Multiple sclerosis

Question 1

what type of disease is MS?

Answer 1

autoimmune disease that targets the myelin sheath in CNS (demyelination)

Question 2

what type of cells are affected in MS

Answer 2

Oligodendrocytes cells responsible for production of myelin in CNS

Question 3

MS more likely occurs in

Answer 3

2x more likely in women (higher prevalence in Caucasian & in colder regions)

Question 4

Onset of MS most often occurs at

Answer 4

20-40 yrs

Question 5

Etiology of MS

Answer 5

• unclear
• Familial tendency (15X more likely): (genetic susceptibility of immune response (MHC/HLA))
• Viral trigger causing autoimmuntiy (Epstein Barr virus)

Question 6

what is the Epstein Barr virus

Answer 6

also known as herpes virus 4, member of herpes virus family, EBV spreads commonly through body fluids primarily saliva, EBV can cause infectious mononucleosis also called mono

Question 7

what is the MHC gene and HLA gene

Answer 7

MHC = major histocompatiblity complex, helps immune system recognize self from foreign substances
HLA= Human leukocyte antigen, gene complex encoding the MHC proteins in humans

Question 8

Patho of MS

Answer 8

• Immune & inflammation damage causing demylenation in CNS — destruction (plaques) causing conduction problems
• oligodendrocyte necrosis
• locations vary: usually affected optic nerve, periventricular region (myelinated fibers around ventricles), Cellebrum, spinal cord, brainstem
• Lymphocyte & macrophage infiltration( aka sclerotic patches)
• motor & sensory neurons affected

Question 9

what causes the sclerotic patches

Answer 9

lymphocyte & macrophage infiltration

Question 10

Mnfts of MS vary

Answer 10

vary by location & extent of plaques

Question 11

Mnfts of MS

Answer 11

• fatigue, visual impairment (usually starts unilateral @ one eye), parathesia (abnormal sensations)
• bowel & bladder dysfunction (b/c regulated from spinal cord cord)-demylinated
• decrease in muscle strength
• coordination & gait problems
• chronic exacerbation & remission

Question 12

what is an important disease process for MS

Answer 12

Chronic exacerbation & remission :

exacerbation–comes back worse than what it was before remission, eventually remissions shorten & leave all together

Question 13

Diagnosing MS

Answer 13

• Hx & presentation (exacterbation & remissions)
• MRI for plaques
• protiens in CSF & increased IgG

Question 14

increased Protein content in CSF tells three things

Answer 14

• autoimmune issue in nervous system
• indicator of inflm in CSF (exudate contains protiens)
• compromised blood brain barrier (protein is a large molecule cannot pass through blood brain barrier)

Question 15

Treatment of Ms

Answer 15

• acute relapse: steroids
• persistent relapse: interferon & methotrexate
• symptomatic – treat symptoms that may arise ex. with bowel & bladder incontinence

Question 16

interferon used for 3 things

Answer 16

• antiviral action (NOT USED FOR MS< FOR THIS)
• anti-inflammatory (helps because substantial inflm, will not use on own for anti-inflm because expensive)
• immunoregulatory role (address autoimmunity, minimizes attack of myelin sheath)

Question 17

Suggestion for why there is exacerbation & remission

Answer 17

inflm follows autoimmunity, oligodendrictyes cells that form myelin sheath. If antiboides increase and the plateua and decline, less target of myelin sheath, may cause oligodendrocytes to produce more myelin (remission)

Question 18

methotrexate properties

Answer 18

• anticancer agent (high dosage used)
• anti-folate (prevents folic acid from doing what it does)
• has immunoregulatory action (cheaper than interferon)