Multiple sclerosis

Multiple sclerosis is an inflammatory disorder characterised by plaques of demyelination throughout the central nervous system. 

There are 3 main patterns: 
  • Relapsing-remitting - 80% 
  • Secondary progressive – up to 50% of relapsing-remitting patients develop this in the first 10 years
  • Primary progressive – 10-15% of cases 

Presentation may be 
  • Optic neuritis 
  • Leg weakness 
  • Diplopia 
  • Ataxia 
  • Bladder/bowel dysregulation

Diagnosis can be made with the aide of: 
  • history and examination giving evidence of CNS lesions scatted in space and time 
  • MRI scan 
  • Visual evoked potential studies showing delayed response 
  • CSF analysis – this should only be used when the diagnosis is uncertain clinically

CSF shows oligoclonal bands. Serum does not have oligoclonal bands. 

Aetiology is unknown – believe to be a combination of genetic and environmental factors. There is 25% concordance in monozygotic twins

  • IV methyprednisolone for acute attacks 
  • Beta interferon 
    • Used if 
      • relapsing-remitting course, can walk 100m unaided and 2 or more relapses in 2 years 
      • secondary progressive and can walk 10m aided, 2 or more relapses in 2 years and minimal increase in disability over the 2 years 
    • main side effect – flu like illness 
  • glatiramer acetate used in relapsing-remitting, if can walk 100m unaided and 2 ore more relapses in 2 years 
  • Baclofen for spasms 
  • Linoleic acid 
    • may reduce progression 
    • sources include sunflower, corn, soya and safflower oils
  • Desmopressin at night if nocturia is a problem 

Small print gem: Uhthoff phenomenon refers to the worsening of vision during fever

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