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



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