3. Es más frecuente en mujeres con relación 2-1
Afecta principalmente a personas entre 20-50 años
La prevalencia estimada en EUA es de 58-95 afectados por
cada 100,000 personas.
De acuerdo a la National Multiple Sclerosis Society,
400,000 individuos están afectados en EUA.
Epidemiología
Noonan CW, Williamson DM, Henry JP, Indian R, Lynch SG, Neuberger JS, et al. The prevalence of multiple sclerosis in 3 US
communities. Prev Chronic Dis. Jan 2010;7(1):A12.
9. Haplotipo HLA-DRB1*1501
Presencia de SNP interleukin-2 receptor alpha
gene (IL2RA) and interleukin-7 receptor alpha
gene (IL7RA).
Teoría viral (islas Faroe e Islandia)
Vitamina D
Múltiples Teorías
10. Chronic cerebrospinal venous insufficiency in
patients with multiple sclerosis.
P Zamboni,1 R Galeotti,1 E Menegatti,1 A M Malagoni,1 G Tacconi,1 S Dall’Ara,1 I Bartolomei,2 F Salvi2
Results: CDMS and TCCS-ECD venous outflow
anomalies were dramatically associated (OR 43, 95% CI
29 to 65, p,0.0001). Subsequently, venography
demonstrated in CDMS, and not in controls, the
presence of multiple severe extracranial stenosis,
affecting the principal cerebrospinal venous segments;
Conclusion: CDMS is strongly associated with CCSVI,
a scenario that has not previously been described,
characterised by abnormal venous haemodynamics
determined by extracranial multiple venous strictures
of unknown origin. The location of venous obstructions
plays a key role in determining the clinical course of
the disease.
Figure 1 B-mode detection of venous stenosis. (A) Right cervical side, high-resolution
B-mode image, transversal access: common carotid artery (CC) with cerebral inflow
(red), and right internal jugular vein (IJVr) with regular cerebral outflow (blue). (B)
Same patient, left side: stenoses of the left internal jugular vein (IJVl) due to annulus
(black arrows) with reflux (red) and severe reduction of the lumen.
11. El embarazo tiene un efecto protector en la EM, especialmente
durante el tercer trimestre cuando se produce una reducción del
70% en la tasa de recaídas en comparación con el año anterior al
embarazo.
Factores solubles inducidos por el feto (corticoides, hormonas,
calcitriol) estimulan una reducción de las citokinas proinflamatorias,
invirtiendo la respuesta TH1 (pro-inflamatoria) a TH2 (anti-
inflamatoria).
Embarazo
Guillain G, Pierre Marie. Sa vie et son oeuvre scientifique. Centenaire de Pierre Marie. Rev Neurol 1952;86(6bis):726-33.
12.
13. Anatomía Patológica
Sitios más frecuentes de lesiones
Periventricular
Cuerpo Calloso
Tronco Encefálico
Médula Espinal
Nervio Óptico
Perdúnculos Cerebelosos
14. El sine qua non de la MS es que deben transcurrir episodios
sintomáticos separados en “tiempo y espacio”
Presentación
15. Multiple Sclerosis Clinical Subtypes
Lublin FD et al. Neurology. 1996;46:907-911.
Relapsing-remitting
Primary-progressive
Disability
Time
Time
Disability
Secondary-progressive
Progressive-relapsing
Time
Time
DisabilityDisability
17. Brain Atrophy Responsible for Depression
in People Battling Multiple Sclerosis
MS Atrophy. Brain images showing location of
hippocampus and its sub-regions in the brain. Bar graph
shows atrophy within these specific hippocampal sub-
regions. Black bars represent the control group; white
bars represent people with MS who are not depressed;
striped bars represent people with MS and depression.
(Credit: Image courtesy of University of California - Los
Angeles)
Se creía que la depresión es causada
por una afectación psicológica
profunda
Los investigadores afirman que la
depresión se debe a una afectación
de una zona específica del
hipocampo
July 01, 2010
18. Fenómeno de Uhthoff
Oftalmoplejía internuclear
Síntomas Asociados
20. En pacientes con solo 1 o 2 lesiones en RM T2 tienen el mismo
riesgo de tener ME que pacientes con 10 o más lesiones
Diagnóstico
21. Clinical Presentation Additional Data Needed for MS Diagnosis
•Two or more attacks
•Objective clinical evidence of 2 or more lesions with reasonable
historical evidence of a prior attack
None; clinical evidence will suffice. Additional evidence (eg, brain
MRI) desirable, but must be consistent with MS
•Two or more attacks
•Objective clinical evidence of 1 lesion
Dissemination in space demonstrated by MRI or
Await further clinical attack implicating a different site
•One attack
•Objective clinical evidence of 2 or more lesions
Dissemination in time demonstrated by MRI or second clinical
attack
•One attack
•Objective clinical evidence of 1 lesion (clinically isolated
syndrome)
Dissemination in space demonstrated by MRI or await a second
clinical attack implicating a different CNS site and Dissemination
in time, demonstrated by MRI or second clinical attack
· Insidious neurologic progression suggestive of MS •One year of disease progression and dissemination in space,
demonstrated by 2 of the following:One or more T2 lesions in
brain, in regions characteristic of MS
•Two or more T2 focal lesions in spinal cord
•Positive CSF
Notes: An attack is defined as a neurologic disturbance of the kind seen in MS. It can be documented by subjective report or by
objective observation, but it must last for at least 24 hours. Pseudoattacks and single paroxysmal episodes must be excluded. To be
considered separate attacks, at least 30 days must elapse between onset of one event and onset of another event.
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the
McDonald criteria. Ann Neurol. Feb 2011;69(2):292-302
22. Hasta en un 95% de los pacientes con ME se encuentran
bandas oligoclonales de IgG en LCR
En un 40% de los pacientes se encuentra una linfocitos y
proteínas, en cantidad anormal, en LCR.
RM de cráneo convencional permite diagnosticar el 95%
del total de casos.
Del 75-90% de los pacientes tienen lesiones visibles por RM
en médula espinal.
Hallazgos Paraclínicos
28. Existing Therapies and
Emerging Therapies for MS
2005 2011
Injectables
IV
Teriflunomide
LaquinimodFTY 720
Oral
Cladribine
Daclizumab
Generic
Mitoxantrone
(oncology) (MS)
Orals
Tysabri
IV
2006 2007
Copaxone
Betaseron
Avonex
Novantrone
Rituximab
II - RRMS; III - PPMS
Rebif
2010 2012
MLN1202
BG 12 Oral
Fumarate
Fampridine
ambulation indication?
MBP 8298
Filed
approved In phase II
In phase III
SB683699
2013
Campath
29. Marcadores de pronóstico desfavorable
Paciente varón
Debut en edad avanzada
Enf. Progresiva desde el comienzo
Signos motores y cerebelosos en el debut
Escasa recuperación de un brote
Corto intervalo entre los dos primeros
brotes
Lesiones múltiples en la RM en el debut
Pronóstico
Marcadores de pronóstico favorable
Neuritis óptica desde el comienzo
Síntomas sensoriales desde el
comienzo
< de 2 recaías en primer año
Mínima alteración después de 5 años