Pathology:                   Demyelinating inflammatorydisease affecting the brain, spinal cord and optic nerve.

Relapsing-remitting type, primaryprogressive, secondary progressive, progressive

relapsing, benign MS


Aetiology:                     Unknown.Proposed mechanisms: autoimmune, genetic, viral (EBV related)


Symptoms:                   Fatigue,spasticity, cognitive impairment, depression, constipation, bladder and sexualdysfunction


Signs:                              Motor and sensory neurological deficits: weakness,transverse myelitis

Visual: Optic neuritis, internuclearophthalmoplegia, extraocular muscle palsies

Lhermitte’s Sign: Electrical shock sensationon neck flexion    

Uhthoff's Sign: Symptoms worse onincreased temperature


Investigations:          Imaging: MRI brain/spine

                                        LumbarPuncture: Oligoclonal bands

                                        Special tests: Visual evoked potentials – prolongedconduction time


Treatment:                  Acute relapses: IV/PO methyl-prednisolone

Severe relapsing remitting MS: Disease-modifying drugs:Beta interferons

 Monoclonal antibodies: Natalizumab, Alemtuzumab

Symptom relief:  Spasticity: Baclofen, Tizanidine,Botulinum Toxin,    

 Fatigue: Amantadine, Modafinil,

 Bladder Spasticity: Oxybutynin

 Erectile Dysfunction: Sildenafil

     Neuropathic Pain: Gabapentin, Pregabalin, Carbamazepine


Complications:          About50% of relapsing remitting MS patients after 10 years progress into secondaryprogressive phase.


Prognosis:                    Averagelife expectancy is lower by ~10 years compared to general population

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