Many questions…..
• What is MS?
• How did I get MS?
• What type of MS do I have?
• Can MS be cured?
• Is it inheritable?
• Can I grow old with MS?
• How will my disease evolve?
Etcetera………
Overview of Module 1
• Demographics• Epidemiology
• Definition and classification
• Clinical course
• Contributing factors
• Understanding the causes of MS • Basic anatomy
• Basic immunology
• Pathophysiology
• Relating pathophysiology to MS symptoms
Race
• Caucasians more than other races• Vikings and Goths?
• African-Americans more aggressive disease course and greaterdisability
• Rare in Maltese, Innuits, Laps, Siberians, Hungarian Gypsies andCentral Asians
Survival
• Not entirely clear
• Probably decreased life expectancy (-7-14 years)
• Dependent of type of MS
• 50% of patients die of directlyMS related causes
• Improving with time
Genetic susceptibility
MS = NOT inherited
Risk increased to 20% when both parents have MS
20% of the patients has a positive family history
Twin studies
What drives twin discordance?
Genome of a pair of monozygotic twins
DNA sequencingDNA methylation IdenticalGene expression
Environment = key driver of twin discordance
Up to 75% of MS cases must be due to non-geneticfactors
Vitamine D
• Birth month: spring > fall• Recent study:
50 babies born in May vs. November: 20% increase of risk in May-babies
• Higher T cells and lower vitamin D levels
• T cells more anti-inflammatory and regulated
Smoking
• Increases the risk of developing MS (40-80%)
• Passive smoking in children!
• Increases the risk of RRMS SPMS
• Disability, lesionload, atrophy
Stress
• May trigger relapses
• Significant increase in relapses in patients living in a war zone
• Stress reduction programme reduces enhancing lesions on MRI
• Bidirectional relationship between endocrine system and immune system
Viral infections
• Viral triggers?• Difficult to investigate
• Might increase risk of developing MS
• EBV, HZV, HSV, HHV-6, Paramyxovirus,…
• Relapse after infection?
Inflammation vs. Degeneration
• RRMS Inflammation vs. Degeneration
• SPMS Inflammation vs. Degeneration
• PPMS Inflammation vs. Degeneration
Positive symptoms
• Hyperexcitability of demyelinated axons
• Ephaptic crosstalk between demyelinated axons
• L’Hermitte
• Trigeminal neuralgia
• Paresthesia/tingling
• Phosphenes
• Pain
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