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20 Cards in this Set
- Front
- Back
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...:
-A life-long chronic autoimmune disease of the central nervous system -The most common cause of demyelinating disease in adults |
Multiple Sclerosis
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There are different courses of MS
“...” (can not be defined initially. defined retrospectively) ...: (most common) ...: (start to deteriorate neurologically overtime) ...: (the worst and the most rare) |
Benign
Relapsing-remitting Secondary progressive Primary progressive |
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MS:
-Most people experience first symptoms between ... and ... years of age -Rare before age ... and after age ... -More common in ... (northern European heritage) -Women affected ... than men -... common in temperate (further away from the equator) climates -Seen more in ... socioeconomic classes |
20 and 40
10 60 Caucasians more More higher |
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Risk of developing MS seems to be set around the age of ...
-It seems like where you grew up has a more important risk factor of developing MS -If you grew up in an area closer to the equator and moved to Michigan, your chances of developing MS is ... |
15
less |
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In MS, myelin is targeted by ... and other immunocompetent cells
This results in inflammation, destruction of myelin, and ultimately in destruction of the axon (nerve fiber) |
lymphocytes
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Is there a test to diagnose MS?
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no
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MS is a ... diagnosis
-Must take a very good ... |
clinical
history |
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People with MS have abnormal MRI normally. should order and MRI with ... (contrast)
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gadolineum
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The diagnosis of MS can only be made when there are separate episodes of demyelination separated by ... and ...
Initially the diagnosis may be “possible” MS -Repeat MRI studies after 3-6 months If new lesions are noted on MRI or if other symptoms occur, the diagnosis of “probable” MS can be made “Definite” MS is defined by a consistent course (relapsing-remitting with at least two bouts separated by at least one month) or a progressive course over six months |
time and space
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Treatment of Exacerbations:
Relapses are usually treated with ... which treat ... -Methylprednisolone (Slou-Medrol) *Administered intravenously *1,000 mg daily for 3-5 days -Prednisone *Administered orally *Tapered over 10-30 days |
steroids
inflammation |
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Steroids have lots of potential side effects
Optic neuritis is never treated with ... steroids first! (treat with ... steroids or nothing at all) High dose steroids ... be discontinued abruptly |
oral
IV should not |
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... Therapy:
Interferon beta 1b (Betaseron): -Injected subcutaneously (under the skin) every other day -Flu-like symptoms and injection site reactions are common when therapy is initiated -There are many strategies to counteract side effects -Should not be used during pregnancy Interferon beta 1a (Avonex) -Administered intramuscularly once a week Interferon beta 1a (Rebif) -Administered subcutaneously three times a week |
Immune Modulating
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Immune modulating therapy:
Therapy with interferons requires routine monitoring of blood work, including ... enzymes and ... function -Blood work should be obtained before initiating therapy, then after one month, then approximately every three to six months -Neutralizing antibodies to the interferons can be measured |
liver
thyroid |
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Immune modulating therapy:
...: -A non-interferon synthetic protein -Administered subcutaneously daily -No flu-like symptoms, but injection site reactions are common -Rarely, there may be a temporary reaction that includes flushing, chest tightness, palpitations, shortness of breath, and anxiety |
Glatiramer acetate (Copaxone)
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Immune modulating therapy:
...: -Human monoclonal antibody -Indicated only for relapsing-remitting MS -Administered by infusion once a month -May increase risk for progressive multifocal leukoencepalopathy (PML) |
Natalizumab (Tysabri)
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... therapy:
Mitoxantrone (Novantrone): -The only FDA approved chemotherapeutic agent for use in secondary progressive MS -Administered as an intravenous infusion every three months -Cumulative lifetime dose (140 mg/m2): roughly 12 treatments over two to three years -Requires regular blood and cardiac monitoring |
immune suppressing
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...:
Acute demyelination of the optic nerve -Decreased vision -Color desaturation Pain with eye movement |
optic neuritis
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...:
-An inflammatory process that is localized over several segments of the spinal cord -Functionally transects the cord -Can be due to infection, vasculitis, or an autoimmune process (may be due to MS) -40% of cases are idiopathic |
Transverse Myelitis
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Transverse Myelitis:
Symptoms Sudden onset of weakness and sensory disturbance below the level of the lesion -Sensory level can usually be found ... dysfunction is common Muscle stretch reflexes below the level of the lesion may be suppressed initially, but will eventually become ... |
Sphincter
hyperactive |
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...:
-An opportunistic infection caused by the JC virus -Occurs in immunocompromised individuals -Characterized by patchy areas of demyelination in the white matter of both cerebral hemispheres -prognosis is poor (usually less than 6 months) |
Progressive multifocal leukoencephalopathy (PML)
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