Multiple Sclerosis - Summary
Multiple Sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system
• Inflammatory demyelination with axonal transection.
• Results in physical disability, cognitive impairment, decreased quality of life
Multiple Sclerosis Epidemiology:
• Female to male sex distribution of nearly 3:1
• MS typically presents in young adults (mean age of onset, 20-30 years)
Presentation - Young adults aged 20 to 30 years with:
• Unilateral optic neuritis
• Partial myelitis
• Sensory disturbances
• Or brainstem syndromes such as internuclear ophthalmoplegia
Atypical Fulminant Forms of MS:
• Tumor-like large multifocal demyelinating lesions:
• Tumefactive demyelination
• Balo’s concentric Sclerosis
• Marburg Variant
Examination:
• UMN signs (Hyperreflexia, Clonus, Babinski’s sign)
• Uhthoff’s phenomena
• Lhermitte’s sign
• Internuclear ophthalmoplegia
• Afferent pupillary defect
SIGNS/SYMPTOMS:
• CENTRAL: Fatigue, Depression, Cognitive impairment, Mood disorder
• MUSCULOSKELETAL:, Spasm, Cramping, Weakness, Ataxia
• GU: Frequent urination, Incontinence
• VISUAL: Nystagmus, Optic neuritis, Diplopia
• MOUTH: Slurring/Stuttering speech, Dysphagia
• GI: Constipation, Diarrhea, incontinence
• SENSES: Tingling, Burning, Paresthesias, Sensitivity to pain, Trigeminal neuralgia
Multiple Sclerosis Diagnosis - Based on a combination of:
1. Signs and symptoms
2. Radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions) McDonald diagnostic criteria for MS
3. Laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands)
- Oligoclonal bands are found in up to 95% of patients with clinically definite MS
4. VEP’s: EEG of visual stimulation
Clinical Course of Multiple Sclerosis:
• Relapsing-remitting MS (FLARE) (85% of pts)
→ Enter a period of progressive decline
→ Secondary Progressive MS
• Primary Progressive MS (Spinal cord predominant) (15% of pts)
→ Steady decline without flares
Multiple Sclerosis Treatment:
• Functionally disabling symptoms with objective evidence of neurologic impairment (Loss of vision, Diplopia, Weakness, and/or cerebellar symptoms)
• Acute:
- IV methylprednisolone 500 to 1000 mg daily 3-5 days
- Oral prednisone (1000 mg to 1250 mg) without an oral taper 3-7 days
- Short course of intramuscular adrenocorticotropin hormone gel
• Refractory Relapse: Plasma exchange (PLEX) or IVIg
#Multiple #sclerosis #diagnosis #management #neurology #treatment #MS