MS.jpg
Multiple Sclerosis seen in an MRI of the neck

Definition

Multiple sclerosis (also or disseminated sclerosis) is a chronic disease of the nervous system. It is an autoimmune condition that results in that demyelination of the central nervous system in at least two different locations. multiple sclerosis patients are prone to relapse.[1]

Prevalence

[2]
1 in 800 lifetime prevalence

Age

Most often in people between the ages of 20 and 40

Gender

Females about 3 times more likely

Risk Factors

[3]
  • Female
  • Northern European decent
  • Family history

Signs and Symptoms

[4]

Pathophysiology

[5]
The initial pathophysiology of Multiple Sclerosis is not well understood with no specific antigen or antibody identified. MS occurs when there is degeneration of myelin sheaths around axon which diminishes the strength of action potentials leading to sensory and motor disturbance. One theory surrounding the pathogenesis involves increased migration of Th-17 cells across the Blood Brain Barrier. These T-cells release IL-17 which disrupts the blood brain barrier and allows them to cross. Once they have crossed they can be cytotoxic towards cells of the Central Nervous System. These cells can be myelin-sensitive which causes inflammation and demyelination. Multiple Sclerosis is characterised by multifocal demyelination disseminated in time and space.

Investigations

[6]

Bloods

Imaging

  • MRI - multiple lesions

Diagnosis

[7]
Diagnosis is made using MRI showing multiple lesions in time and space (ie new lesions in an MRI at a later date)

Differentials to rule out

Treatment

[8]

Non-Pharmacological

  • Physical Exercise
  • Physiotherapy (for motor problems)
  • Plasma exchange may work in relapsing patients

Pharmacological

  • Corticosteroids (IV or oral)
  • Interferons β
  • Glatiramer acetate (daily SC injections)
  • Teriflunomide (daily tablet)
  • Fingolimod (daily tablet)
  • Dimethyl fumarate (BD tablet)
  • Immunomodulators (such as Natalizumab)

Management

[9]
Patients should be reassessed every 6 to 12 months if they are stable. If there are any relapses they should see a healthcare professional immediately and review whether acute treatment is required.

Complications

[10]

Prognosis

[11]
Some patients respond well to treatment and have good prognosis whereas other patients do not respond to treatment, suffer frequent relapses and may quickly become disabled;

See Also

Medscape - MS
BMJ Best Practice - Multiple Sclerosis

Citation

Multiple Sclerosis MRI image: Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org. From the case rID: 2635
  1. ^ Oxford Concise Medical Dictionary, "multiple sclerosis"
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  3. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  5. ^ Dynamed - Multiple Sclerosis
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html
  11. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/140.html