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
- 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
NICE guideline: Multiple sclerosis. Available at http://guidance.nice.org.uk/CG8/NICEGuidance/pdf/English
Barten, L. et al. New approaches in the management of multiple sclerosis. Drug Des Devel Ther. 2010; 24(4): 343-366.