Multiple Sclerosis Quiz

Multiple Sclerosis (MS)

• MS is an autoimmune disease of the central nervous system (CNS), affecting the brain and spinal cord.
• It typically affects young adults (onset between 20 and 40 years old) and females more often than males.
• MS impacts cognitive, emotional, motor, sensory, or visual functions.

Incidence and Prevalence

• The incidence of MS has increased significantly over the past century.
• Globally, there are approximately 2.5 million affected people.
• In the UK (2018), over 130,000 people were affected.
• Incidence rates vary significantly across continents and countries.
• In England, the incidence rate is 190 per 100,000 people.
• In Scotland, the incidence rate is 290 per 100,000 people.
• The female-to-male ratio is around 3:1, having been 2:1 in the 1950s.

Environmental Factors

• Sunlight/Vitamin D: A link exists between vitamin D deficiency and MS.
• Tobacco Exposure: Exposure to tobacco has been linked to MS.
• Obesity: Obesity has been examined as a possible factor in MS.
• Viral Exposure (Epstein-Barr Virus): A strong association between EBV infection and a heightened risk of developing MS exists. Studies show higher rates of EBV infection in people with MS compared to control groups. This suggests a causal relationship with MS. Infected people were 32 times more likely to develop MS compared to uninfected individuals.

Genetic Factors

• There is an increased risk of developing MS among close family members.
• The prevalence of familial MS is around 13%.
• First-degree relatives (parent, children, sibling) have a risk of 2.5-5% of developing MS.
• Identical twins with MS present a risk of 20-25% for the other twin.
• Genome-wide association studies have identified approximately 200 immune-related genes linked to MS susceptibility.

Pathology

• Inflammation and Demyelination: Inflammation in the brain and spinal cord leads to demyelination, damaging the myelin sheath which is crucial for signal transmission.
• Inflammatory Infiltrates: Lymphocytes and macrophages are prevalent in inflammatory infiltrates within the CNS.
• Axonal Damage: Axonal degeneration is a significant cause of irreversible deficits in MS.
• Consequences: MS can present as acute loss of function, repairable damage with remission potential, or chronic damage. In primary progressive MS, up to 5% of the spinal cord cross-sectional area can be lost annually. Chronic lesions in MS are linked to average axon loss of ~68% or more.

Clinical Features

• Relapse: The primary cause of relapse is often a conduction block.
• Remission: Restoration of conduction after a relapse.
• Positive Phenomena: Hyperexcitability, ectopic impulses, and mechanosensitivity may be present.
• Progression: Persistent loss of conduction and axonal damage.

Clinical Presentation

• There is a relationship between relapsing-remitting and progressive MS.
• Around 20% of patients exhibit primary progressive MS symptoms from onset.
• Relapsing-remitting MS can lead to a progressive form of MS (secondary progressive).
• Symptoms are often similar to other diseases, making diagnosis difficult.

Diagnosis

• MRI scans are used to look for white matter abnormalities and spinal lesions in the diagnosis of MS.
• Cerebrospinal fluid (CSF) markers are also considered during the process. A combination of factors, including clinical course, MRI results, and CSF analysis are essential for consistent diagnosis.
• McDonald diagnostic criteria guide the diagnostic process.

Treatments

• Medical treatments can improve or stabilize the severity of MS early.
• Disease-Modifying Treatments (DMTs): Medications aim to reduce or prevent relapses and disease progression.
• Symptomatic Treatments: Medications or therapies that target specific symptoms.
• Steroids (High Dose Corticosteroids): Used to treat acute relapses. Steroids are commonly used in hospitalized patients. Oral or intravenous methylprednisolone are frequent options.
• Natalizumab (Tysabri): A monoclonal antibody that inhibits leucocyte migration into the CNS.
• Fingolimod (Gilenya): A sphingosine analogue that sequesters lymphocytes in lymph nodes.
• Dimethyl Fumarate (Tecfidera): Anti-inflammatory agent.
• Alemtuzumab: Anti-CD52 antibody that reduces immune response. Also considered an anti-inflammatory agent.
• Teriflunomide (Aubagio) : Immunomodulator.

Other

• Vitamin D: While some studies suggest a link between vitamin D and MS prevention, there's no clinical trial evidence recommending it as a treatment for MS.

Support & Organizations

• Organizations like the MS Society offer resources, research, and support for individuals impacted by MS.
• The World Health Organization created a global action plan for epilepsy and other neurological disorders

Test your knowledge about Multiple Sclerosis with this quiz. Covering topics such as risk factors, prevalence, and pathology, you'll learn key facts about this complex neurological condition. Perfect for students and healthcare professionals alike.