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Pathology
Demyelinating inflammatory disease affecting the brain, spinal cord and optic nerve.
Relapsing-remitting type, primary progressive, secondary progressive, progressive
relapsing, benign MS
Aetiology
Unknown. Proposed mechanisms: autoimmune, genetic, viral (EBV related)
Signs
Motor and sensory neurological deficits: weakness, transverse myelitis
Visual: Optic neuritis, internuclear ophthalmoplegia, extraocular muscle palsies
Lhermitte’s Sign: Electrical shock sensation on neck flexion
Uhthoff's Sign: Symptoms worse on increased temperature
Symptoms
Fatigue, spasticity, cognitive impairment, depression, constipation, bladder and sexual dysfunction
Investigations
Imaging: MRI brain/spine
Lumbar Puncture: Oligoclonal bands
Special tests: Visual evoke
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
Prognosis
Average life expectancy is lower by ~10 years compared to general population
About 50% of relapsing remitting MS patients after 10 years progress into secondary progressive phase.
Key Facts
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Key Images
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Key References
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