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
