EMmedonline

• Multiple sclerosis is a chronic disease characterised by inflammation, demyelination, gliosis & neuronal loss; the course can be relapsing-remitting or progressive.

CLINICAL FEATURE

• Around 80% of patients have a relapsing & remitting clinical course of episodic dyfunction of CNS with variable recovery. 20% shows a slow progressive clinical course.

• Onset of MS may be abrupt or insidious .

• Weakness of the limbs may manifest as loss of strength, speed or dexterity as fatigue or a disturbance of gait. Excercise induced weakness is a characteristic of MS. Pyramidal signs like spasticity, hyperreflexia & babinski's sign. Occasionally tendon reflex may be lost.

• Spascticity of legs

• Optic neuritis presents as diminished visual acuity, dimness or decreased color perception in the central field of vision. These symptoms can be mild or may progress to severe visual loss. Fundoscopic examination may be normal or reveal optic disc swelling .Optic atrophy may follow optic neuritis.

• Diplopia due to internuclear opthalmoplegia or 6^th nerve palsy.

• Visual blurring is due to either optic neuritis or diplopia

• Sensory symptoms include both paresthesias & hypesthesia. Pain occur anywhere in the body and change from time to time.

• Ataxia, cerebellar dysarthria.

• Bladder dysfunction is present in >90%

• Constipation occurs in >30% of cases.

• Facial weakness due to lesion in the pons.

• Vertigo due to brainstem lesion.

• Cognitive dysfunction , depression, sexual dysfunction.

• Uhthoff's symptom: Neurological symptoms produced by an elevation of core body temperature , it is due to transient conduction block.

• Lhermitte's symptom is an electric shock like sensation that radiates down the back into legs.

• Trigeminal neuralgia, hemifacial spasm & glossophayngeal neuralgia.

DISEASE COURSE

• Relapsing/remitting MS (85% ) , characterized by discrete attacks that generally evolve over days to week , often complete recovery ensues over weeks to months.

• Secondary progressive MS (SPMS) always begins as RRMS. During the course of the disease a steady deterioration in function unassociated with acute attacks.

• Primary progressive MS(15%) , the patient do not experience symptoms but only a steady functional decline from disease onset.

• Progressive/relapsing MS they over lap PPMS & SPMS (5%).

INVESTIGATIONS

• MRI

• Visually evoked potential

• CSF STUDY : Lymphocytic pleocytosis or protein >100mg/dl.

TREATMENT

• Acute attacks:

  • Methylprednisolone IV 500 -1000 mg/d for 3-5 days, Followed by prednisolone 60-80 mg/d & gradually tapered over 2 weeks.

  • PPI for gastritis

  • Lithium 300mg BD for mood stabilisation

  • Palsma exchange may be beneficial.

• Prevention of relapse or disease modifiying agent

  • Interferon beta, glairamer acetate,azathioprine, cyclophospamide, plasmapheresis, IV immunoglobulin.

Udated on 24/02/2013