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Overview of Multiple Sclerosis
Valerie Robinson, D.O.
What is it?
• Multiple sclerosis is an inflammatory demyelinating disease, likely auto-immune.
• Affects the CNS• Causes multifocal areas of demyelination• Most commonly affects women of childbearing
age who are of Northern European descent.• There is a multiple-gene component
• Siblings 3-5%, Twins 20-40%
Signs and Symptoms
• Relapses and Remissions• Optic neuritis• Internuclear opthomoplegia• Sensory irregularities• Pain• Vertigo• Muscle weakness, spasticity, paraparesis or
paraplegia• Bowel/bladder/sexual dysfunction
Signs and Symptoms• Fatigue• Depression• Cognitive dysfunction• Difficulty with coordination• McDonald’s criteria
– multiple lesions are separated in space and time
• Uhthoff’s phenomenon – worsening of symptoms when the body temp increases
• Lhermitte’s sign – feeling of electric shock running down back and limbs upon
neck flexion
Diagnosis
• Clinical judgment confirmed by the following:• MRI shows demyelinated plaques that meet
McDonald’s criteria• CSF analysis: increased IgG, oligoclonal bands• Abnormal evoked potentials (visual,
somatosensory, and brainstem auditory)• Onset between age 15 and 50• Before 16 is considered pediatric = 5%
Exacerbations/Relapses
Acute neurologic impairment causing loss of function or severe discomfort.• Pregnancy, particularly 2-3 months post-
partum• Stress• Random
Types of MS
• Relapsing-remitting (RRMS): clear relapses with full or partial recovery. No progression between relapses.
• Primary-progressive (PPMS): From onset, disease progresses with occasional plateaus and temporary minor improvements.
• Secondary-progressive (SPMS): Onset as RRMS then begins to progress. With or without relapses, minor improvements and plateaus.
• Progressive-relapsing (PRMS): From onset, disease progresses. It has occasional clear relapses with full or partial recovery. Progression continues between relapses.
Differential
• CVA/TIA• Malignancy• Spinal cord injury or compression• A-V malformations• Lupus• Sjogren’s• Cerebellitis• Infections: such as meningitis, human T-
lymphocytic virus type 1, HIV, syphilis
Treatment of Progressive
• Immunosuppression– Azathioprine– Cladribine– Dalfampridine– Glucocorticoids– Cyclophosphamide– Cyclosporine
• Stem sell transplant
– Glatiramer acetate– Interferon– Methotrexate– Mitoxantrone– Natalizumab– Rituximab
• Total lymphoid irradiation
Treatment of Relapsing
• #1 Glucocorticoids• Interferon• Glatiramer acetate• Natalizumab• Plasma exchange if poor response to steroids
• Methylprednisolone 1 gram IV QD x 3-7 days– Pediatric: 20-30 mg/kg QD x 5 days
• May follow with a prednisone taper for residual disability
References
• Up-to-Date– Diagnosis of multiple sclerosis in adults– Epidemiology and clinical features of multiple sclerosis in
adults– Treatment of progressive multiple sclerosis in adults– Treatment of acute exacerbations of multiple sclerosis in
adults– Treatment of relapsing-remitting multiple sclerosis in
adults– Treatment and prognosis of pediatric multiple sclerosis