Multiple sclerosis

Multiple sclerosis (MS) is a demyelinating central nervous system condition clinically defined by two episodes of neurological dysfunction (brain, spinal cord, or optic nerves) that are separated in space and time.

Classically presents in white women, aged between 20 and 40 years, with temporary visual or sensory loss. However, it may affect either sex and any age or ethnic group, and may have variable neurological symptom location and/or duration.

The patient may have subtle changes in vision, ambulation, and reflexes on examination that provide evidence of previous attacks (which may not have been noticed by the patient).

Magnetic resonance imaging (MRI) of both the brain and spinal cord is important in diagnosis. Brain MRI is sensitive, but very susceptible to over-interpretation in the absence of clinical correlation. Spinal cord MRI is abnormal less often, but lends greater specificity when present with brain lesions.

Treatment of MS can be divided into three parts: treatment of the acute attack; prevention of future attacks by reducing triggers and use of disease-modifying therapies; and symptomatic treatments of neurological difficulties such as spasticity, pain, fatigue, and bladder dysfunction.

Multiple sclerosis (MS) is defined as an inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least two areas of the central nervous system (brain, spinal cord, and optic nerves) separated in time and space.[1]Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol. 2005 Dec;58(6):840-6. https://onlinelibrary.wiley.com/doi/full/10.1002/ana.20703 http://www.ncbi.nlm.nih.gov/pubmed/16283615?tool=bestpractice.com

BMJ talk medicine: multiple sclerosis