Multiple Sclerosis Certified Specialist
Exam Graded A+
adaptive immunity - ANSWER-Antibodies that are produced to pathogens serve as an
immunologic memory. Compromised primarily of lympthocytic B cells, which produce
the antibodies that attach to specific antigens and T cells.
Advanced Disease - ANSWER-
Age of onset - ANSWER-Strikes between the ages of 15 to 60 years. Highest incidence
occurs between the age of 30 and 50 years.
Alemtuzumab (Genzyme) - ANSWER-Given via IV infusion for 5 days initially and for 3
days one year later.
Shown to significantly reduce relapse rate and worsening of disability compared to Rebif
over the 2 year study period.
Adverse reaction: development of autoimmune thyroid-related adverse event, develop
immune thrombocytopenia (ITP)
Axons - ANSWER-Carry impulses away from the cell body
Nerve Fibers
Benign MS - ANSWER-Patients who have rare attacks and are minimally disables 20
years after being diagnose with MS. About 10% of MS patients experience a "benign
course" of MS.
Brainstem - ANSWER-Internuclear opthalmoplegia, 6th nerve palsy, nultifocal signs
(facial sensory loss, vertigo, hearing loss, ataxia, dysarthria)
central neuropathic pain - ANSWER-Intermittent spontaneous, paroxysmal pain
described as shooting, stabbing, shock like pain, lancinating, crushing, or searing
CIS and DMT - ANSWER-Early treatemtn can enefically impact the change of a CIS
progressing toCDMS. ADditionaly more recent stuies have demosntated that early
treatment can decrease the rate of disability progression in those patients who develop
CDMS.
Clinically Isolated Syndrome (CIS) - ANSWER-A term that describes a first clinical
episode with features suggestive of multiple sclerosis. Usually occurs in young adults
and affects optic nerves, brainstem, or the spinal cord. They usually recover from their
presenting episode. It is often the first manifestation of MS.
, CMSC advises the use of imaging in Patients as follows:
Diagnosis-
Follow-up- - ANSWER-Diagnosis: Use Gd-enhanced MR as baseline imaging
Follow-up: uSe MRI before initiating DMT and to demonstrate any new activity.
Common symptoms - ANSWER-Ambulation problems, bladder and bowel dysfunction,
cognitive dysfunction, fatigue, mood disturbances, pain and other sensory changes.
sexual dysfunction, speech problems, swallowing difficulties, tremor, vision problems.
Corticosteroids - ANSWER-Decreased inflammation, reduce edema, and help to
preserve the integrity of the BBB. Decreases the duration of relapse and helps to speed
recovery byt does not affect long term progression of disease activity.
Typical course: Oral Methylpredinisone (MP) of atleast 500mg once daily for 5 days or
IV 1g daily for 3 days.
Depression and use of interferons - ANSWER-Patients with a history of depression may
experience an increase of depressive symptoms on interferon beta meds. Patients who
become depressed on an interferon beta meds may need to switch to a non interferon.
Diagnostic Criteria- 6 points - ANSWER-1. Age (10-50 years old)
2. Objective neurologic signs on exam
3. Neurologic symptoms and signs that are of CNS white matter origin
4. Dissemination (spreading) in time- 2 or more attacks lasting at least 24 hours and
separated by at least 1 month or progression of signs and symptoms over 6 months
5. Spreading out in space
6. No other explanation of symptoms
CLINICALLY DEFINITE IF 5 OUT OF 6 CRITERIA MET- always including the last
criteria
Diagnostic findings of CSF indicative of MS - ANSWER-Elevated IgG levels, increased
IgG index, presence of oligoclonal bands
evoked potential testing - ANSWER-measure electrical activity in the brain in response
to stimulation of sight, sound, or touch
Record the nervous system's electrical response to stimulation of specific sensory
pathways. Because damage to myelin results in a slowing of response time, EPs can
sometimes provide evidence of scarring along nerve pathways that does not show up
during neurologic exam.
Fingolimod (Gilenya) - ANSWER-Daily, capsule taken orally
Headache, flu, diarrhea, back pain, liver enzyme elevations and cough. Less common:
slowed heart rate following first dose, infections, and macular edema.
Exam Graded A+
adaptive immunity - ANSWER-Antibodies that are produced to pathogens serve as an
immunologic memory. Compromised primarily of lympthocytic B cells, which produce
the antibodies that attach to specific antigens and T cells.
Advanced Disease - ANSWER-
Age of onset - ANSWER-Strikes between the ages of 15 to 60 years. Highest incidence
occurs between the age of 30 and 50 years.
Alemtuzumab (Genzyme) - ANSWER-Given via IV infusion for 5 days initially and for 3
days one year later.
Shown to significantly reduce relapse rate and worsening of disability compared to Rebif
over the 2 year study period.
Adverse reaction: development of autoimmune thyroid-related adverse event, develop
immune thrombocytopenia (ITP)
Axons - ANSWER-Carry impulses away from the cell body
Nerve Fibers
Benign MS - ANSWER-Patients who have rare attacks and are minimally disables 20
years after being diagnose with MS. About 10% of MS patients experience a "benign
course" of MS.
Brainstem - ANSWER-Internuclear opthalmoplegia, 6th nerve palsy, nultifocal signs
(facial sensory loss, vertigo, hearing loss, ataxia, dysarthria)
central neuropathic pain - ANSWER-Intermittent spontaneous, paroxysmal pain
described as shooting, stabbing, shock like pain, lancinating, crushing, or searing
CIS and DMT - ANSWER-Early treatemtn can enefically impact the change of a CIS
progressing toCDMS. ADditionaly more recent stuies have demosntated that early
treatment can decrease the rate of disability progression in those patients who develop
CDMS.
Clinically Isolated Syndrome (CIS) - ANSWER-A term that describes a first clinical
episode with features suggestive of multiple sclerosis. Usually occurs in young adults
and affects optic nerves, brainstem, or the spinal cord. They usually recover from their
presenting episode. It is often the first manifestation of MS.
, CMSC advises the use of imaging in Patients as follows:
Diagnosis-
Follow-up- - ANSWER-Diagnosis: Use Gd-enhanced MR as baseline imaging
Follow-up: uSe MRI before initiating DMT and to demonstrate any new activity.
Common symptoms - ANSWER-Ambulation problems, bladder and bowel dysfunction,
cognitive dysfunction, fatigue, mood disturbances, pain and other sensory changes.
sexual dysfunction, speech problems, swallowing difficulties, tremor, vision problems.
Corticosteroids - ANSWER-Decreased inflammation, reduce edema, and help to
preserve the integrity of the BBB. Decreases the duration of relapse and helps to speed
recovery byt does not affect long term progression of disease activity.
Typical course: Oral Methylpredinisone (MP) of atleast 500mg once daily for 5 days or
IV 1g daily for 3 days.
Depression and use of interferons - ANSWER-Patients with a history of depression may
experience an increase of depressive symptoms on interferon beta meds. Patients who
become depressed on an interferon beta meds may need to switch to a non interferon.
Diagnostic Criteria- 6 points - ANSWER-1. Age (10-50 years old)
2. Objective neurologic signs on exam
3. Neurologic symptoms and signs that are of CNS white matter origin
4. Dissemination (spreading) in time- 2 or more attacks lasting at least 24 hours and
separated by at least 1 month or progression of signs and symptoms over 6 months
5. Spreading out in space
6. No other explanation of symptoms
CLINICALLY DEFINITE IF 5 OUT OF 6 CRITERIA MET- always including the last
criteria
Diagnostic findings of CSF indicative of MS - ANSWER-Elevated IgG levels, increased
IgG index, presence of oligoclonal bands
evoked potential testing - ANSWER-measure electrical activity in the brain in response
to stimulation of sight, sound, or touch
Record the nervous system's electrical response to stimulation of specific sensory
pathways. Because damage to myelin results in a slowing of response time, EPs can
sometimes provide evidence of scarring along nerve pathways that does not show up
during neurologic exam.
Fingolimod (Gilenya) - ANSWER-Daily, capsule taken orally
Headache, flu, diarrhea, back pain, liver enzyme elevations and cough. Less common:
slowed heart rate following first dose, infections, and macular edema.
