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19 Cards in this Set
- Front
- Back
Myelin
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High fat content, allows for faster more efficient conduction of electrical impulses; formed by oligodendrocyte in the CNS (Schwann cell in PNS); Loss of myelin leads to slowing of conduction and may progress to damage of the underlying nerve
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Acute Transverse Myelitis
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(1) Spinal cord dysfunction; (2) back pain, ascending sensory level, sphincter disturbance, paraparesis; (3) Many viral etiologies proposed; (4) May be the first episode of MS, especially is brain MRI is abnormal. ATM lesions tend to extend over 3 or more vertebral segments, more extensive than lesions of MS
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Optic Neuritis
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Acute or subacute onset of monocular visual blurring or loss, central blind spot; 90% of patients have PAIN with eye movement, loss of color vision, poor acuity, and an APD
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Neuromyelitis Optica (Devic’s Disease)
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Transverse myelitis and optic neuritis (often bilateral); Spinal cord MRI with longitudinally extensive lesion >2 vertebral levels; CSF shows PMN pleocytosis; Pathology differs from MS - there is an anti-NMO IgG antibody!
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Acute Disseminated Encephalomyelitis (ADEM)
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Acute demyelinating illness which commonly follows an infection or vaccination - more common in children; MRI shows bilateral symmetric inflammatory changes of the same age; ADEM is usally monophasic, but may be recurrent
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Multiple Sclerosis
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Idiopathic inflammatory demyelinating disease of CNS; Episodes of neurologic dysfunction "disseminated in time and space"; MCC of non-traumatic neurologic disability in young adults
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Unfavorable Prognostic Factors in MS
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(1) High MRI lesion burden at first episode; (2) Moderate-to-severe disability at 5 years; (3) Progressive clinical course from onset; (4) Male gender; (5) Late onset (age > 40 years); (6) Two or more relapses in first year
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Initial symptoms in MS
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(1) Sensory in limbs - 31%; (2) Visual loss - 16%; (3) Motor loss/slowing - 9%
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Motor Symptoms in MS
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(1) Corticospinal and corticobulbar tract lesions - UMN spastic weakness, spastic paraparesis is most common; (2) Cerebellar pathways - ataxia, tremor, incoordination, scanning speech usually occur later in course
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Sensory symptoms in MS
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(1) Occur in 75% of patients during course of disease; (2) Spinothalamic tract lesions common, resulting in dysesthesias, pain; (3) Dorsal column involvement less common
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Lhermitte's phenomenon
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Electric sensation passing down back and limbs upon flexion of neck
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Internuclear ophthalmoplegia
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Due to lesion in medial longitudinal fasciculus (MLF). Inability to adduct ipsilateral eye, with nystagmus on abduction of contralateral eye.
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Cognitive changes in MS
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Cognitive compromise in up to 60% of MS patients on detailed testing. “Subcortical” dementia: information processing, visuospatial, memory, executive dysfunction.
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Increased immunoglobulin production/Oligoclonal bands in MS
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Presence of 2 or more antibody clones. Indicates damaged blood-brain barrier or immunoglobulin production in the brain.
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MS drugs
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Avonex, Betaseron, Copaxone, Rebif (CRAB drugs) - only available by injection
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Interferon Adverse Events
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(1) Injection site reactions; (2) Flu-like complex in 60-70%; (3) Depression in 2%; (4) Elevated LFTs
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CRAB Drugs: The Bottom Line
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(1) Comparative trials are small, poorly controlled; (2) Differential trial designs make comparison from one agent to another difficult; (3) Each agent has its place in treatment in relapsing-remitting MS (RRMS); (4) Must be individualized to each patient
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Other drugs for MS
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(1) Tysabri - risk of PML! (2) Mitoxantrone - risk of cardiac toxicity, leukemia
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Symptomatic Treatment in MS
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SPASTICITY: (1) baclofen, tizanidine, dantrolene, botox, PT
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