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Multiple Sclerosis
• CNS disorder
• Scar formation on outside of nerve cells of brain and spinal cord
• Inflammation destroys covering of nerve cells leaving scar tissue
• Nerve cells cannot transmit impulses
Symptoms
• Optic neuritis• Numbness / weakness in
extremities• Instability in walking• Tremors• Loss of bladder control• Heat intolerance• Fatigue
Diagnosis by Exclusion
• Encephalitis• CNS Vasculitis• Lyme Disease• Behet Syndrome• Sarcoidosis• Syphilis• Leukodystrophies
• Lupus Erythematosus• Spastic Paraparesis• Vitamin B-12 Deficiency• Sjogren’s Syndrome• Hereditary Degenerative
Disorder• Multifocal
Leukoencephalopathy
Criteria for Diagnosis
History of two attacks with
positive oligoclonal bands
or
increased IgG in CSF
Criteria for Diagnosis
History of two attacks with
clinical and paraclinical evidence of lesions, oligoclonal bands, and
increased IgG in CSF
Criteria for Diagnosis
History of two attacks with
clinical evidence of at least one lesion, and clinical or paraclinical
evidence of another lesion
IEF Theory
• Stable pH gradient with carrier ampholytes in an electrical field
• Proteins exhibit net + or – charge
IEF Theory
• Stable pH gradient with carrier ampholytes in an electrical field
• Proteins exhibit net + or – charge
• Migrate toward electrode of opposite charge
IEF Theory
• Stable pH gradient with carrier ampholytes in an electrical field
• Proteins exhibit net + or – charge
• Migrate toward electrode of opposite charge
• Rate of migration ↓ as it reaches isoelectric point
IEF Theory
• Stable pH gradient with carrier ampholytes in an electrical field
• Proteins exhibit net + or – charge
• Migrate toward electrode of opposite charge
• Rate of migration ↓ as it reaches isoelectric point (pI)
• Protein focuses at pI
IEF Theory• Stable pH gradient with carrier
ampholytes in an electrical field• Proteins exhibit net + or – charge• Migrate toward electrode of
opposite charge• Rate of migration ↓ as it reaches
isoelectric point (pI)• Protein focuses at pI; some drift
but regains charge and migrates back
Interpretation
Compare CSF and Serum
Looking for intrathecal synthesis
indicated by
oligoclonal bands in CSF
but not in serum