Multiple sclerosis

Question 1

What is MS?

Answer 1

Autoimmune inflammatory disease that attacks myelinated axons in the CNS

Question 2

What are the common symptoms of MS?

Answer 2

Sensory/motor:

• numbness/tingling in arms + legs
• electric current sensation dow back/legs
• useless hand syndrome

Vision:

• blurred vision
• vision loss
• diplopia

Question 3

Which symptoms are less commonly associated with the onset of MS?

Answer 3

• bladder dysfunction
• heat intolerance (heat causes nerves to conduct less efficiently)
• pain, movement disorders
• dementia

Question 4

What characteristics of MS are detected on MRI?

Answer 4

T2/Flair lesion shows dissemination in space (>2 CNS areas): periventricular, supratentorial, spinal cord, cerebellum, also corpus callosum

T2/Flair lesion shows dissemination in time - development of one new lesion after seeing an old one

Brain atrophy

Question 5

Why is a lumbar puncture taken in MS?

Answer 5

Compares components of CSF to plasma (e.g. presence of blood cells, lymphocytes)
Measures neurofilaments: if high = indicative of ongoing nerve loss

Question 6

What are the diagnostic criteria for MS?

Answer 6

Neurological symptoms needs to occur in >1 place int eh CNS (brain, spinal cord, optic nerve = dissemination in space)
Needs to be a chronic condition = dissemination in time
Must rule out all other possible diagnoses

Question 7

What are the different types of MS?

Answer 7

1. relapsing-remitting = attack will occur but will go back to baseline (most common type - 75-90%)
2. secondary progressive = if R-R s not treated the condition will become progressive
3. primary progressive = pt never relapses + progressively gets worse
4. Progressive-relapsing = between relapses (attacks of symptoms) the disease will continue to get worse

progressing subclinically = NEDA

Question 8

What are the potential causes of MS?

Answer 8

Viral infection of neurones
Mitochondrial dysfunction
Release of heat shock

Question 9

What are the stages of forming a chronic active/chronic inactive MS lesion?

Answer 9

**it is a demyelinating disease
Cells involved: neurones; astrocytes; oligodendrocytes’ microglia
Pre-active lesion = activated microglia and loss of myelin
Active lesion = lymphocyte infiltration around the blood vessels

Chronic active lesion = lymphocytes spread out around lesion
- macrophages engulf myelin and sit on the lesion edge

Chronic inactive lesion = attempt at remyelination
- will form an astrocytic scar

Question 10

What drug is commonly given during an “MS attack”?

Answer 10

High dose prednisolone (steroid) - reduce inflammation

Question 11

What are the 2 strategies of treatment?

Answer 11

1. Maintenance-escalation: drugs that are not super effective but won’t have many side effects
2. Induction: very aggressive anti-inflammatory drugs with serious side effects

Question 12

What are the first line and second line DMTs in MS?

Answer 12

First line:

• Escalation = injectables (IFNb + GA), natalizumab
• Induction = alemtuzumab, mitoxantrone, HSCT

Second line:

• fingolimod
• natalizumab
• HSCT