Patho Test 5 (1Of2) - Multiple Sclerosis

Front 1

What arm of the nervous system is involved in MS (i.e., central or peripheral)?

Back 1

CNS (i.e., brain and spinal cord)

Front 2

What specifically does the immune system “attack” in multiple sclerosis?

affect on the nervous system?

Back 2

Myelin-effecting the conductivity of the action potential (nerve impulse) traveling along the axon

Front 3

What is myelin?

Back 3

insulation sheath that surrounds the nerve fibers (axons) located in the CNS

Front 4

Give examples of what de-myelination will have nervous system.

Back 4

fatigue, disturbances of vision, strength, coordination, balance, sensations, bladder and bowl function

Front 5

Why was this disease called “multiple sclerosis”?

Back 5

Multiple= many areas of the CNS
Sclerosis= scars of plaques

Front 6

What are the four functions of astrocytes?

Back 6

1. Formation of the blood-brain barrier
2. Neurotransmitter reuptake and release
3. Regulation of ion concentration in the extracellular space
4. Promotion of the myelinating activity of the oligodendrocytes

Front 7

What is the function of microglia cells?

Back 7

-macrophages (of brain and spinal cord)
-immune defense of the CNS

Front 8

What is the function of Oligondendrocytes?

Back 8

Myelination:
-of the neuronal axons
-can myelinate 50 axons (1um sheath)

Front 9

Why is it that no two MS patients have exactly the same symptoms?

Back 9

Symptoms depend on:
-locations of the lesions within CNS

Front 10

What are the 4 subtypes of MS?

Back 10

1. relapsing-remitting
2. secondary progressive
3. primary progressive
4. progressive relapsing

Front 11

The least common of all subtypes of MS is called?

Back 11

Type 4: Progressive Relapsing MS

steady neurologic decline but also suffer clear superimposed attacks

Front 12

The initial course of all subtypes of MS are called what?

Back 12

Type 1: Relapsing-remitting MS

unpredictable relapses followed by periods of months to years of relative quiet (remission)

Front 13

Sometimes called “galloping MS”, describes around 65% of those with an initial relapsing-remitting MS are called what?

Back 13

Type 2: Secondary progressive MS

begin to have progressive neurologic decline between acute attacks without any definite periods of remission

Front 14

Which MS is this called?

Back 14

Type 4: Progressive Relapsing MS

steady neurologic decline but also suffer clear superimposed attacks

Front 15

Which MS is this called?

Back 15

Type 3: Primary Progressive MS

~10-15%
never have remission after their initial MS symptoms

Front 16

Which MS is this called?

Back 16

Type 1: Relapsing-remitting MS

unpredictable relapses followed by periods of months to years of relative quiet (remission)

Front 17

Which MS is this called?

Back 17

Type 2: Secondary progressive MS

begin to have progressive neurologic decline between acute attacks without any definite periods of remission

Front 18

In the genetics of MS, explain ethnicity risk for MS in terms of alleles.

Back 18

Africa: < 0.5 per 100,000
East Asia: 2.8 per 100,000
Americas: 8.3 per 100,000
Europe: 80 per 100,000
Northern European Descent: 200 Per 100,000

Front 19

What is the chief candidate for the environmental triggers of MS?

Back 19

Epstein-Barr Virus

Front 20

Does EBV “cause” the disease (i.e. infect the cells of the CNS)?

Back 20

-No
-immune response to this virus is different in MS patients

Front 21

What system of the body actually causes the disease?

Back 21

-altered immune response

EX. EBV "mimics" myelin sheath

Front 22

What autoreactive lymphocyte initiates the pathology of MS?

Back 22

Th1 and Th2 cells

Front 23

What role do B cells play in the pathology of MS?

Back 23

Activated B:
-enter the CNS
-become plasma cells
-produce antibodies against myelin sheath
-activate the complement system
-cause inflammation / demyelination

Front 24

What role do CD8+ cells play in the pathology of MS?

Back 24

-Attack oligodentrocytes
-cause demyelination

Front 25

What type of lesions in the CNS are identified by contrast magnetic resonance imaging (MRI)?

Back 25

Active Lesions

MRI contrast agents (gadolinium):
-improve visibility (internal body structures)
-administered orally or intravenously
-exposed to strong magnetic field
-radiofrequency pulse
-causes the atoms in the contrast agents to spin
-then relax after the pulse stops
-detected by the scanner
-mathematically converted to an image

Front 26

Explain diagnosis of MS by the presence or absence of oligoclonal bands of IgG in the plasma and cerebral spinal fluid.

Back 26

Immunoglobins produced in CNS IF:
+Oligoclonal bands in CSF
--(absent) in blood serum

-79%-90% MS patients observable oligoclonal bands

Front 27

What medical procedure is performed to sample cerebral spinal fluid?

Back 27

-Lumbar puncture or Spinal tap
-electrophoresis of CSF
-presence of oligoclonal bands in the CSF

Front 28

Whether it be sensory evoked potentials, visual and auditory evoked potentials, what does the latency tell you about the nerve being tested?

Back 28

Speed (ms) of nerve action potential

*Latency / amplitude:
-compared to the "normal"

Front 29

Whether it be sensory evoked potentials, visual and auditory evoked potentials, what does the amplitude tell you about the nerve being tested?

Back 29

Strength (mV) of nerve action potential

*Latency / amplitude:
-compared to the "normal"

Front 30

Interferon beta-1a (Rebif) and Interferon beta-1b (Betaseron):

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 30

Immunomodulators

Front 31

This mode of treatment is counterindicated during relapsing periods:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 31

Exercise

Front 32

During symptomatic attacks (i.e., acute relapses) high doses are used but this treatment is only effective for the short term in relieving symptoms:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 32

Corticosteroids (e.g. methylprednisolone)

Front 33

Appear to reduce the movement of Th1 into the central nervous system by interfering with the Th1 integrin receptor molecules adhering to the VCAM-1 endothelial adhesion molecule:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 33

Humanized Monoclonal Antibody

Front 34

These immune suppressing drugs have little to no impact on recovering function after the attack or prevention of new attacks:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 34

Corticosteroids (e.g. Methylprednisolone)

Front 35

Glatiramer acetate (Copaxone):

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 35

Immunomodulators

Front 36

Mitoxantrone, a topoisomerase inhibitor, disrupts DNA synthesis and DNA repair:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 36

Cancer chemotherapeutic Drug

Front 37

Shifts population of T cells from proinflammatory Th1 to regulatory T cells that suppresses inflammation:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 37

Immunomodulators

Front 38

Reduces T-cell activation and proliferation and reduces secretion of pro-inflammatory mediators:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 38

Immunomodulators

Front 39

When using this mode of treatment, it is important for the physical therapist to guard against hyperthermia in that thermal stress can result in decreased motor function and increased symptomatology:

What is the type of management of MS for this:
a. Corticosteroids (e.g., methylprednisolone)
b. Immunomodulators
c. Cancer chemotherapeutic Drug
d. Humanized Monoclonal antibody
e. Exercise

Back 39

Exercise