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14 Cards in this Set
- Front
- Back
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Multiple Sclerosis
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-CNS condition involving UMN's
-autoimmune demyelination disease of the spinal cord and brain -second leading cause of disability in young people; age of onset is 20-30 -usually first presents with optic neuritis, then progression to UMN deficits -relapse is common(new neurological deficit that appears in pt); corresponds to a new MS attack as a result of a new lesion |
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LMN Signs
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-weakness, atrophy, decreased tone, areflexia, fasciculations
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UMN Signs
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-characteristic of MS
-weakness, spasticity, increased tone, hyperreflexia, Babinski sign |
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Classic MS Patient
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-acute optic neuritis
-evidence of active and past lesions on MRI of the brain(MRI is essential for diagnosis) -positive oligoclonal bands |
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Another classic MS patient
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-partial transverse myelitis
-evidence of past lesions on MRI of the brain -evidence of optic neuritis -pt exhibits separation of time and space of symptoms |
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MS Classifications
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1. Primary Progressive
2. Relapsing Remitting |
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Primary Progressive MS
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-around 10-15% of patients
-very cumulative from the beginning -first occurrence, have a relapse and dont get much better, and continue to get worse with each relapse -more often seen in young men |
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Relapsing Remitting MS
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-about 85% of patients
-pts are fine, relapse, recover, relapse, recover, etc -may have a few lingering defects such as afferent pupil defect, but they remain functional -after about 10-15 yrs, pt will get into an area of secondary progression -> no new lesions, just getting worse |
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Causes of MS
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-T Cells
-Genetics -Low Vitamin D -Eppstein-Barr virus |
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T Cells
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1. Auto-reactive T cells - attack myelin
2. T cell imbalance -TH1: pro-inflammatory; elevated levels, *therapy seeks to lower T1:T2 ratio -TH2: anti-inflammatory; treatment aims to increase these 3. MS Plaque - myelin loss seen as a light area in imaging** |
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Genetics
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-30% MS risk
-2 DRB-150 copies increase risk -first autoimmune disease shown to have genetic linkage to HLA |
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Vitamin D
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-studies report lower Vit D levels in MS pts
-higher incidence of MS at higher altitudes-> correlates to vit D influence(possibly from less sun exposure) |
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First line drugs
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1. Interferon B: was first drug on market; has multiple effects; injectable; causes flu-like symptoms; increases TH2 count
2. Glatiramer acetate: subcutaneous injection that is given daily; is an amino acid compound that mimics myelin protein; causes alteration in immunity, pts do not have relapse; increases TH2 count; no flu-like symptoms 3. Fingolimod: first oral treatment; derived from myriocin(fungus); blocks Sphingosine-1-phosphate receptors(keeps activated T cells from egressing from the lymph nodes) |
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Second line drugs
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1. Tysabri: strongest MS drug; prevents active T cells from crossing the blood/brain barrier; pts on the drug for a long time have been shown to develop Progressive Multifocal Leukoencephalopathy (PML)...life-threatening
2. Mitoxantrone: only used when pt is degrading rapidly and has failed other treatments; very toxic |
