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MULTIPLE SCLEROSIS, MOGAD - Coggle Diagram

- - - - α4β1 integrin on T cells that binds to VCAM-1
        
        T effector cells adhere to endothelial cells
        
        T cells migrate to areas of inflammation in CNS
        
        demyelination
        
        lesions located in white matter or cortex
        
        optic neuritis
        
        acute inflammation of optic nerve
        
        8 more items...
        
        internuclear ophthalmoplegia (IMO)
        
        lesion to medial longitudinal fasciculus
        
        2 more items...
        
        trigeminal neuralgia
        
        severe shooting unilateral facial pain
        
        cerebellar syndromes
        
        nystagmus, dysarthria, ataxia
        
        transverse myelitis
        
        numbness/paresthesia, weakness, spasticity, other UMN signs
        
        Lhermitte's sign (electric sensation upon neck flexion), Uhthoff's phenomenon (exacerbation with heat), fatigue, cognitive difficulties
        
        clinical prodrome
        
        depression/anxiety, fatigue, pain, headache, GI, genitourinary, sleep, increased healthcare use 5 years prior
        
        MRI with contrast
        
        multiple lesions of differing ages
        
        1 more item...
      - natalizumab (monoclonal antibody for VLA-4)
        
        risk of developing PML if JCV positive
    - - fingolimod (S1PR agonist)
        
        traps T cells in lymph nodes (acts as functional antagonist)
    - - suppress T cell activation, control cytokine secretion, induce differentiation of neural stem cells to oligodendrocytes
  - - - CSF-restricted oligoclonal bands
- - - - disability accrues over time
  - - - sometimes stop relapses altogether
        
        siponimod
  - - - disability accrues independently
        
        ocrelizumab
- - - - flow cytometry live-cell based assay