Multiple Sclerosis Overview Quiz

Practise Questions - Summary

• Multiple sclerosis: A demyelinating disease of the central nervous system, not always a relapsing/remitting disease course. (False)
• MS characteristics: Secondary progressive MS has a long progressive phase, followed by a remission, and then a second long progressive phase. Most common in women over 60. Symptoms vary widely, from minimal signs to severe disability and death. Myelin sheath thins due to inflammation/degeneration.
• MS prevalence: Higher at lower latitudes, linked to sun/UVB exposure and vitamin D levels. (True)
• MS aetiology: The most important genetic factor is MHC haplotype. Having an identical twin with MS increases the risk. EBV infection may be a necessary but not sufficient trigger. Blood-brain barrier prevents immune cells from directly entering the CNS, but B cells and auto-antibodies are involved. (False statement is: B cells that produce autoantibodies reactive to components of myelin are NOT involved in the pathogenesis of MS.)
• MS therapies: Many disease-modifying therapies exist, but none actively repair damaged CNS. (True)
• MS therapy safety profile (safest first): Interferon beta (Cytokine therapy), Ocrelizumab (B-cell therapy), Natalizumab (anti a4 integrin therapy), Alemtuzumab (anti-CD52 depleting antibody therapy), HSC transplantation.

Peripheral Nervous System and Nerve Bundles

• Peripheral Nervous System: Made up of peripheral nerves, nerve roots, and ganglia.
• Sensory Neuron Cell Bodies: Located in the Dorsal Root Ganglion.
• Nerve Bundles/Fascicles: Composed of numerous axons from motor and/or sensory neurons.
• Peripheral Nerve Regeneration: Endoneurium and Schwann cells play key roles. (True)

Neurological Syndromes and Symptoms

• Glove and stocking syndrome: Predominant loss of sensation in distal extremities.
• Mononeuropathy: Specific deficits from a single affected nerve.
• Mononeuritis multiplex: Asymmetrical deficits from multiple affected nerves.
• Polyneuropathy: Affects numerous peripheral nerves.
• Polyradiculoneuropathy: Affects multiple nerve roots.
• Chronic Diabetic Neuropathy: Example of axonal axonopathy.
• Guillain-Barré Syndrome: Acute-onset disease, can be initially demyelinating.
• Nissl bodies: Accumulations of rough ER in neuronal cell bodies, indicative of healthy protein production.
• Wallerian degeneration: Occurs in the distal axon.

Other Neurological Conditions

• Multiple Sclerosis related notes: relapsing-remitting, secondary-progressive, primary-progressive, and relapsing-progressive MS.
• Pathological findings:
• Amyloid plaques: Extracellular accumulation of amyloid beta peptides
• Neurofibrillary tangles: Intracellular accumulation of hyperphosphorylated tau protein
• Motor symptoms: rigidity, bradykinesia, akinesia
• Non-motor symptoms: depression, hyposmia, sleep disorders.
• Risk Factors for Parkinson's Disease: Age, male sex, pesticide exposure, and head injury history.
• Prodromal Symptoms: Constipation, loss of smell, dementia, dysphagia, REM sleep behaviour disorder, bradykinesia, and depression.
• Acetylcholine: Neurotransmitter at neuromuscular junctions.
• Amyotrophic Lateral Sclerosis (ALS/FTD): Motor neuron loss, typically characterized by progressive muscle weakness, leading to paralysis, and is caused by both genetic and environmental factors.
• Symptoms of AD: Mild mood changes, confusion, memory loss, poor judgment, wandering, restlessness, significant weight loss, increased sleeping, loss of bladder/bowel control, dependence, language impairments, sundowning.
• Compensatory increase: Increase of Acetylcholine receptors in denervated muscle fibres.
• Gene editing/silencing: CRISPR technology or preventing the production of a mutant protein.
• Mechanisms of action: (includes gamma-secretase inhibitors - have effects on other important proteins, beta secretase inhibitors - difficult to penetrate the BBB, inhibition of Aβ aggregation, and stimulation of enzymes).
• Immunotherapy: Active and passive immunotherapy against amyloid beta - shows progress.
• Tau Protein: Under normal conditions it stabilizes microtubules and regulates axonal transport.
• Glioblastomas: Grade IV tumors that rarely spread to the subarachnoid space, and invade rapidly.

Test your knowledge on multiple sclerosis (MS) with this comprehensive quiz. Explore key characteristics, prevalence factors, and the underlying aetiology of MS. This quiz is designed to deepen your understanding of this complex demyelinating disease.