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Multiple Sclerosis Teaching course, #EFNS, basics by Mind Map: Multiple Sclerosis Teaching course,
#EFNS, basics
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Multiple Sclerosis Teaching course, #EFNS, basics

First speaker

Pathogenesis of MS Finn Sellebjerg Copenhagen, Denmark


Recent discoveries, Brain 2011, Haider, if you look at MS lesion w normal appearing white matter, areas can be highlighted where there's oxidative damage already, Oxidative changes and inflammation, Inflammation in MS subtypes, acute, relapsing-remitting, Recovery process, slide missed... nice research on this

Inflammatory demyelinating diseases, Peripheral nervous system, central nervous system, MS, Subtypes

Pathologyof MS, Classicalpathology, Mc Alpine's MS (1998), Peterson et al, Ann Neurol 2001, Cortical demyelination, Axonal and neuronal damage, Structure of myelin (node of ranvier), Baumannand pham-dinh, physiol Rev 2001, Pathophysiology of MS notonly demyelination, demyelination, conduction block, axonal loss, neuronal loss, Classical demyelinating lesion, Frischer et al, Brain 2009, immunopathogenesis, 15 years ago, MS mediated by T cells, Today: soo much more, Regulatory T cells, Inflammatory cells, Weiner ann neurol 2009, T helper 17, T helper 2, pro inflammatory cytokines, CD8 cytotoxic T cells, Treatment, Alemtuzumab in relapsing remitting MS, coles et al, J. Neurol 2006

Etiology of MS: multi factorial, Ebers, Lancet Neurol 2008, IMSGC and WTCCC, Nature 2011, Environment, vitamin D, Smoking, infection, Genetics, HLA alleles, other "immune genes", Other genes, Immunity, Adaptive, innate

PApers, Multiple sclerosis: a two-stage disease?, relapsing-remitting, secondary progression, influential papers, steinman,nat immunol 2001, Compston and coles, lancet 2002, Is it true?, Secundary vs primary progressive MS, missing notes, internet conection issues, Inflammation & degeneration.. or both?, Inflammatory demyelinasion, Relapsingforms, relapsing-remitting, progressive relapsing, secondary progressive, non-relapsing, primary progressive, without relapses, prediction was, Relepsing forms: more inflammation, Non-relapsing: more degeneration, However...., reality is, inflammation and degeneration in both forms, then.. is it a 2 stage disease?

Clinical disease courses, New node

Second Speaker

Epidemiology and course of MS Christian Confavreux Lyon, France


The Facts, Frequency, 100-200/100000 incidence, distribution, demogrpahic characteristics, geographical distribution is subject to high variations, Davenport, 1921, Handbook of clinical neurology, Volume 47 on MS, MS prevalence in French farmers, the closer to equator the lower prevalence, Vukusic et al 2007, nj neurol neurosurg psychiat, north of France much higher prevalence than south part, MS prevalence in French General population, North east, high relative risk, Fromont et al brain 2010, Effect of migrations, Compston,, kahana et al j neurol 1994, Age-specific prevalence of MS ni Israel, AGe-specific prevalence of MS in Frest West Indies, cobre et al 2005 Brain, moving early in life increases the risk, Some notes missed...internet connection, French cohort: sex-ratio, Female > male, Age of onset, French cohort of 30.000 patients, from 1950-2005: age of onset went up.. from 23 to 33, Female to male ratio: no of females relatively increases, Race and relative, Familial aggregation, Reference: McAlpine's MS 4th edition, Associated genes, HLA-DRB1*15, increases risk by factor 3, IL2-R, IL7-R

Interpretation of the facts, Exogeneous factors, Geography, Macro environment, MS in migrants, acquired in infancy, Demographic changes, "modern world", Familial aggregation, No effect of the familial micro-environment, Twins, ?, Endogeneous factors, Geography, "homo scandinavicus" effect, Genetic, North to south gradient in geographical distribution, Familial aggegation, genetic sharing load, ?, Infections, Direct effects, no micro-organism consistently found to be present in the CNS of MS patients, transmission failures, Indirect effects, references, poskanzer 1993, analogy poliomyelitis / hygiene hypothesis, Lower hygiene, early exposure to pathogens: immunological protection, Measles, EBV, Ultraviolet exposure

Environmental suspects, Infections, hygiene hypothesis, chemico-physical environment, sun exposre, vitamin D, Contraceptive pill, jobb, tobacco, Life expectancy, Epigenetic, Also differential in gender, life expectancy, contraceptive pill, job, tobacco

Conclusion, multi factorial origin of risk for developing disease

Third Speaker

The management of MS Hans-Peter Hartung Dusseldorf, Germany

The diagnosis of MS


Making diagnosis:, History, Neurological exam, MRI (brain / spinal), MRI, Dissemination in space, dissemination in time, inflammation, CSF analyses, (Evoked potentials)

Is this consistent with CNS inflammatory demyelination or not?, age of onset, temporal evolution of deficit (including recovery), nature of deficit, clinical features which challenge a diagnosis of MS

McDonald revised criteria for MS, 2010

Laboratory methods to exclude other pathologies, CSF, Blood, Urine

Some notes missing

Differential diagnosis in MS, Lisak et al 2004, Neuromyelitis optica, wingerchuk et al, neurology 2006, Major criteria, Minor criteria

Therapy, First line treatment, Avonex, betaferon, rebif, Glatiramer, REGARD trial, BEYOND trial, Oçonnor Lancet neurol 2009, Second line treatment, missed slide, COmie et al 2009, kappos et al 2006, jacobs et al NEJM 2000, kinkel et al neurology 2006, champions study group neurology 2006, MS therapy consensu group (MSTCG) immunotherapy in MS, Relapse therapy, Basic therapy, AFFIRM trial: phase III natalizumab, Lancet 2011, Hans Peter Hartung, Havrdovaet al Lancet Neurol 2009