Multiple Sclerosis Teaching course, #EFNS, basics

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

1. First speaker

1.1. Pathogenesis of MS Finn Sellebjerg Copenhagen, Denmark

1.2. Talk

1.2.1. 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 Recovery process slide missed... nice research on this

1.2.2. Inflammatory demyelinating diseases Peripheral nervous system central nervous system MS

1.2.3. Pathologyof MS Classicalpathology Mc Alpine's MS (1998) Peterson et al, Ann Neurol 2001 Structure of myelin (node of ranvier) Pathophysiology of MS notonly demyelination Classical demyelinating lesion immunopathogenesis 15 years ago Today: soo much more Treatment

1.2.4. 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

1.2.5. PApers Multiple sclerosis: a two-stage disease? relapsing-remitting secondary progression influential papers Is it true? Secundary vs primary progressive MS missing notes Inflammation & degeneration.. or both? Inflammatory demyelinasion prediction was However....

1.2.6. Clinical disease courses New node

2. Second Speaker

2.1. Epidemiology and course of MS Christian Confavreux Lyon, France

2.2. Talk

2.2.1. 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 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

2.2.2. Interpretation of the facts Exogeneous factors Geography MS in migrants Demographic changes Familial aggregation Twins ? Endogeneous factors Geography Familial aggegation ? Infections Direct effects Indirect effects Ultraviolet exposure

2.2.3. 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

2.2.4. Conclusion multi factorial origin of risk for developing disease

3. Third Speaker

3.1. The management of MS Hans-Peter Hartung Dusseldorf, Germany

3.2. The diagnosis of MS

3.3. Talk

3.3.1. Making diagnosis: History Neurological exam MRI (brain / spinal) MRI CSF analyses (Evoked potentials)

3.3.2. 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

3.3.3. McDonald revised criteria for MS, 2010

3.3.4. Laboratory methods to exclude other pathologies CSF Blood Urine

3.3.5. Some notes missing

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

3.3.7. 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