Spreading Emergency Medicine Across the Globe ..
emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
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 6th 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
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor