Multiple sclerosis

5
(1)

Introduction:

Multiple sclerosis (MS) is an autoimmune disease of the CNS characterized by:

  1. Chronic inflammation
  2. Demyelination
  3. Gliosis (scarring)
  4. Neuronal loss.

Pathophysiology:

  1. Activated T cells disrupt blood brain barrier (type 4 hypersensitivity)
  2. Some B cells form myelin-specific autoantibodiies, causing demyelination (hallmark of MS).

 

Site of involvement (demyelination):

The classical 4 locations of MS lesions are :

  1. Periventricular
  2. Juxtacortical
  3. Infratentorial and
  4. Spinal cord.

Classical of MS is dissemination in space & time:

  1. Dissemination in space: Lesions in different locations
  2. Dissemination in time: Lesions at different stages of activity, i.e. (old + new) lesions.

C/F:

  1. Earliest symptom: Sensory loss → Heat sensitivity (Uhthoff ’s symptom)
    • Uhthoff’s phenomenon is the worsening of neurologic symptoms in multiple sclerosis and other demyelinating conditions when the body gets overheated.
  2. Retrobulbar neuritis:
    • Gradual painful loss of vision
    • Optic disc margin is normal as the inflammation is behind the eyeball
    • Pain on attempted elevation (SR) / adduction (MR).
  3. Spasticity.

Types:

According to Harrison 20th, there are 3 types:

  • A. Relapsing MS (RMS)
  • B. Secondary progressive MS (SPMS)
  • C. Primary progressive MS (PPMS).

Investigation:

A. MRI:

  • MAGNIMS imaging diagnostic criteria
  • Defined locations characteristic for MS:
    1. Periventricular (minimum 3 lesions)
    2. Cortical
    3. Infratentorial
    4. Spinal cord
    5. Optic neuritis.

B. CSF: Oligoclonal bands on liquid chromatograph: assesses intrathecal production of IgG.

Gallery

  1. Dawson’s fingers: Areas of demyelination perpendicular to the sagittal surface of ventricle
  2. Open ring sign: It is a relatively specific sign for demyelination.

Severity grading: Expanded Disability Status Scale (EDSS)

Treatment:

  1. DOC of acute attack: Methylprednisolone
  2. Diesase modifying agents:
    1. Interferon β
    2. Glatiramer Acetate
    3. Fingolimod (sphingosine-1-phosphate [S1P] inhibitor)
    4. Natalizumab (Highly Effective): Humanized monoclonal antibody directed against the α4 subunit of α4β1 integrin, a cellular adhesion molecule expressed on the surface of lymphocytes. The major concern with long-term treatment is risk of PML, which increases in subsequent years of treatment.
    5. Ocrelizumab (humanized monoclonal antibody directed against the CD20 molecule present on the surface of mature B cells)
    6. Teriflunomide (inhibits the mitochondrial enzyme dihydro-orotate dehydrogenase, which is a key part of the pathway for de novo pyrimidine biosynthesis; thus limiting the proliferation of rapidly dividing T and B cells)
    7. Alemtuzumab (humanized monoclonal antibody directed against the CD52 antigen that is expressed on both monocytes and lymphocytes)
    8. Mitoxantrone (risk of cardiotoxicity & acute leukemia, rarely used now).

Disclaimer:

Images used in this webpage to describe the topic(s) properly to the audience might be copyrighted under other person(s) or publishing house(s) or respective company. We have solely used them for non-commercial educational purpose only; not intended to any unfair means or copyright violation. Still if you want any image(s) to be removed from this webpage, please leave a message to prithwi201@gmail.com with proper evidence of authorization (link to original work and allegedly infringing url) and we will not hesitate to process your request as early as possible and delete the respective image(s). Thank you for cooperating with us.

How useful was this post?

Click on a star to rate it!

Average rating 5 / 5. Vote count: 1

No votes so far! Be the first to rate this post.

Leave a Reply

Your email address will not be published.