Multiple Sclerosis - Summary
Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system -> inflammatory demyelination with axonal transection.  Results in physical disability, cognitive impairment, decreased quality of life
EPIDEMIOLOGY:
 - Female to male sex distribution of nearly 3: 1
 - MS typically presents in young adults (mean age of onset, 20-30 years)
PRESENTATION - Young adults aged 20 to 30 years with:
 - unilateral optic neuritis
 - partial myelitis
 - sensory disturbances
 - or brainstem syndromes such as internuclear ophthalmoplegia
SYMPTOMS:
 • CENTRAL: Fatigue, Depression, Cognitive impairment, Mood disorder
 • MUSCULOSKELETAL:, Spasm, Cramping, Weakness, Ataxia
 • GU: Frequent urination, Incontinence
 • VISUAL: Nystagmus, Optic neuritis, Diplopia
 • MOUTH: Slurring/Stuttering speech, Dysphagia
 • GI: Constipation, Diarrhea, incontinence
 • SENSES: Tingling, Burning, Paresthesias, Sensitivity to pain, Trigeminal neuralgia
DIAGNOSIS - Diagnosis is made based on a combination of :
  (1) signs and symptoms
  (2) radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions) - McDonald diagnostic criteria for MS
  (3) laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands) - Oligoclonal bands are found in up to 95% of patients with clinically definite MS
  (4) VEP's: EEG of visual stimulation
TREATMENT
 • Acute:
    - IV methylprednisolone 500 to 1000 mg daily, 3-5 days
    - Oral prednisone (1000 mg to 1250 mg) an oral taper, 3-7 days
    - Short course of intramuscular adrenocorticotropin hormone gel.
 • Refractory Relapse: Plasma exchange (PLEX) or IVIg

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