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
