@AANMember @Neurology__ Board week ahead. Here are some high yield points on #MultipleSclerosis multiple sclerosis that might have been missed in older board reviews. All the best #MedEd #neurotwitter #tweetorial #NeurologyRF @WashUNeurology @harvardneuromds @AaronLBerkowitz

1. 2017 Revision to Mc Donald Criteria- (a) Any two, any new lesions qualify for #diagnosis of #MultipleSclerosis (b) Cortical lesions also count (not just juxtacortical) (c) presence of Oligoclonal bands in CSF and not serum satisfy dissemination in time criteria

2. Serum Neurofilament Light chain correlates with disease activity and response to treatment in #MultipleSclerosis

3. Central Vein Sign resembling "coffee bean" or "doughnut" may be useful for distinguishing #MultipleSclerosis lesions from other white matter lesions, e.g., #migraine Sati, P. et al. Nat Rev Neurol 12, 714–722 (2016)

4. Young man presents with ataxia, nystagmus, MRI below, LP x 2 negative for OCB. Be mindful of CLIPPERS. Steroid responsive, lymphocytes present but no demyelination. Case courtesy of Dr Vahe Michael Zohrabian, http://Radiopaedia.org , rID: 42630

5. MS, NMO and MOG Ab associated disease are separate entities. Great slides from @AANMember Dr. Aaron Miller from @MtSinaiNeuroRes

6. Paroxysmal symptoms in #MultipleSclerosis can include trigeminal neuralgias, dyskinesias, dysarthrias, hemifacial spasm, etc. Treat new paroxysmal symptoms like exacerbation with IV steroids. Use CBZ, OXC, GBP, etc.

7. Drug Mechanisms -- Natalizumab blocks alpha 4 integrin preventing migration of T lymphocytes into brain | Alemtuzumab blocks CD 52 on mature lymphocytes (both B and T), thus is also used in CLL | Ocrelizumab blocks CD20 receptor on B cells

8. Fingolimod downregulates S1P causing sequestration of autoreactive lymphocytes (both B and T) in lymphoid tissue. Causes bradycardia. #Ozanimod now FDA approved spares the heart. | Teriflunomide inhibits pyrimidine synthesis

9. Alemtuzumab has high efficacy (annual dosing) but is notorious to cause thyroiditis, immune thrombocytopenia, glomerular disease, even stroke, arterial dissection, etc. FDA approves use after failing two other medications.

Hope this is helpful, please share @LakhotiaMD @dfreedman7 @rena_diana #NeuroTwitter @shashank_agarMD @FastTpa @YoungNIR