Super MS lecture. Basic Facts about MS. Demyelinating Conditions. Multiple Sclerosis Progressive Multifocal Leukoencephalopathy Acute Disseminated Encephalomyelopathy (ADEM) Post infectious, post-vaccinial leukoencephalitis Infection induced demyelination
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Basic Facts about MS
Bizarre bodies in oligos,
MS is a chronic, inflammatory disease of the CNS in which most patients incur disability over time. MS affects approximately 400,000 people in the United States, two thirds of whom are women. Disease onset typically occurs in young adults between the ages of 20 and 40.
Distinct patterns of multiple sclerosis pathology indicates heterogeneity in pathogenesisLucchinetti, et al.BRAIN PATHOLOGY6: (3) 259-274 JUL 1996
NEJM 349(2):139-145 heterogeneity in pathogenesisJuly 10, 2003Antimyelin Antibodies as a Predictor of Clinically Definite Multiple Sclerosis after a First Demyelinating EventThomas Berger,MD et al
There are distinctive disease patterns in MS. In each case a person experiences sudden deterioration in normal physical abilities that may range from mild to severe. This attack, sometimes referred to as an exacerbation of MS, may last a brief time or continue for months.About 80% of patients begin with Relapsing-Remitting (RR) MS, the most common pattern. In this form, patients experience a series of attacks followed by complete or partial disappearance of the symptoms (remitting) until another attack occurs (relapse). It may be weeks to years between relapses.
In Primary- Progressive (PP) MS, there is a gradual decline in physical abilities.About 20% of patients begin with PP-MS. At least half of patients starting with relapsing remitting MS eventually develop a secondary progressive pattern within 10 or so years. A rarer pattern is called Progressive-Relapsing (PR) MS is characterized by a steady decline in abilities accompanied by frequent attacks. Some patients, 10-30% have so called “benign” MS, a patient experiences an initial attack followed by little or no progression. Finally, there is a rare, rapidly progressive form of MS called malignant MS.
Types of MS at Presentation heterogeneity in pathogenesis
MS Prognosis in 15-20 Yrs. (Pre-ABC’s) heterogeneity in pathogenesis
Percentage of Patients who will require Assistive Devices heterogeneity in pathogenesis
Series of MRI scans in one patient
Humanized monoclonal antibody against α4-Integrin on lymphocyte surface
Preliminary trial in 72 patients over 24 weeks, a Phase II trial showed decrease in T2 MRI lesions
Blocks the attachment of WBC to endothelium preventing migration into the CNS
Microscopic Picture of Axon and Myelin heterogeneity in pathogenesis
MS is almost unheard of in European gypsies, Eskimos and African Bantus and rare in native Americans, Japanese and other Asian groups.. The chance of having MS increases in families where a first-degree relative has the disease. Thus, a brother, sister, parent, or child of a person with MS stands a one to three-percent chance of developing MS. Similarly, an identical twin runs a 30% chance of acquiring MS whereas a non- identical twin has only a four-percent chance if the other twin has the disease. These statistics suggest a strong role for both heredity and environmental factors.