5 - multiple sclerosis

What is multiple sclerosis?

transient neurological dysfunction secondary to focal demyelination of the nervous system

What type of disease in MS?

likely autoimmune with genetic and environmental components → race, FHx, genetic polymorphisms, latitude

What is a clinically isolated syndrome?

first episode of neurological symptoms that last at least 24 hours and is caused by inflammation or demyelination in the CNS

What is the McDonald criteria for MS?

1. find evidence of damage in 2 different areas of CNS that occurred at least 1 month apart → separated in space and time

2. rule out all the possible diagnoses

How do we use visually evoked potentials (VEP) in MS?

can help confirm diagnosis by identifying a demyelinating event that caused no clinical symptoms

What is the epidemiology of MS?

1. women

2. primarily Caucasians

3. increased risk with family history

What are the types of MS?

relapsing-remitting MS

primary progressive MS

secondary progressive MS

What is relapsing-remitting MS (RRMS)?

relapses/flare ups followed by complete or partial recovery periods → symptoms improve and there is no apparent progression of disease

What is the most common type of MS?

relapsing-remitting MS

What is primary-progressive MS (PPMS)?

steadily worsening with no remission

rate of progression may vary over time with occasional plateaus and improvements → no distinct relapses or remissions

What is secondary progressive MS (SPMS)?

late stage RRMS → RRMS steadily progressive with or without relapses

what are the most common symptoms of MS?

1. weakness or numbness in one or more limbs

2. optic neuritis

3. tremor and ataxic gait

4. double vision, dysarthria, dizziness

5. fatigue

What are the management goals of MS?

1. treat the symptoms

2. reduce likelihood of exacerbations, occurrences of new white matter lesions

3. delaying disability

What was the first drug approved for PPMS?

Ocervus (Ocrelizumab)

What did the CHAMPS study tell us?

interferon beta has a 44% reduction in a 3 year probability of developing clinical MS in those with one acute demyelinating event

what is the prognosis for MS?

slow progression → most do not become severely disabled

2/3 are still able to walk 20 yrs after diagnosis