Question 20

Joe has been diagnosed with Multiple Sclerosis. What is the pathophysiology of MS? (What is happening that is causing the disease?)

1.) Multiple Sclerosis is a condition in which the CNS of a person presents a special kind of distributed lesions. It is an immune-mediated inflammatory disease that attacks myelinated axons in the CNS, destroying the myelin and the axon in different ways. [Amanda]

2.) To add to Amanda’s post, demyelination can cause neurons to be more susceptible to necrosis or apoptosis (cell death). The demyelination is the cause of the relapses, but the axon loss and cell death lead to long-term disability. (Tiffany)

3.) One important thing to remember regarding the pathophysiology of MS is that where the demyelination occurs is specific to every person. This is important because where the demyelination occurs influences what the signs and symptoms the individual presents with. (Kelly)

To add to Tiffany's post, the lesions that occur due to the demyelination are called plaques. (Laura)
http://emedicine.medscape.com/article/1146199-overview#a0104

4.) MS is possibly an auto-immune disease, and it does have some genetic components. The demyelination of axons causes many symptoms in a person with this disease. Some of the common signs that Joe presented with are double vision, and sensory symptoms being first complaints of a patient. He also presented with short term memory loss, where cognitive issues are a common symptom of MS. (Britt)

5.) Adding onto what Britt had mentioned about having genetic components . Several genetic variants have been found to increase the risk of developing MS. They inlcude variants that are located on chromosomes 1, 5, 6 (in the HLA-DRA region), 10, 11, 12 and 16. http://www.decodeme.com/multiple-sclerosis

These can be witnessed through a special scan to determine your risk variants of these specific chromosomes.(Zach)

7.) The inflammation that occurs with MS is caused by T-cells. The T-cells infiltrate into the brain through the blood-brain barrier (which is usually not accessible to T-cells, unless it is affected by a virus), which decreases the strength of the junctions forming the barrier. The Tcells become locked within the brain and attack the myelin because the Tcells view myelin as a virus.The resulting inflammatory response causes swelling and activates other immune cells and antibodies. (Erin) http://www.multiplesclerosisinformation.co.uk/#/pathophysiology/4534171371

7) Following up after Tiff and Amanda, according to NIH, the times of remission are due to either these damaged axons receiving some degree of restoration in function. This may be due to remyelination of damaged axons, repaied conduction to damaged axons, or the cessation of inflammation. (Brittany)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692682/

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