Multiple sclerosis

Last reviewed: 26 Aug 2022
Last updated: 05 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • visual disturbance in one eye
  • peculiar sensory phenomena
More key diagnostic factors

Other diagnostic factors

  • female sex
  • age 20-40 years
  • foot dragging or slapping
  • leg cramping
  • fatigue
  • urinary frequency
  • bowel dysfunction
  • spasticity/increased muscle tone
  • increased deep tendon reflexes
  • imbalance/incoordination
  • pale optic disc or non-correctable visual loss
  • incorrect responses to Ishihara colour blindness test plates
  • abnormal eye movements
Other diagnostic factors

Risk factors

  • female sex
  • family history of MS
  • northern latitude
  • genetic factors
  • smoking
  • vitamin D deficiency
  • autoimmune disease
  • Epstein-Barr virus
  • overweight/obesity in children and adolescents
More risk factors

Diagnostic investigations

1st investigations to order

  • MRI - brain
  • MRI - spinal cord
  • FBC
  • comprehensive metabolic panel
  • thyroid-stimulating hormone
  • vitamin B12
More 1st investigations to order

Investigations to consider

  • antibody testing for neuromyelitis optica spectrum disorders (NMOSD)
  • cerebrospinal fluid evaluation
  • evoked potentials
More investigations to consider

Treatment algorithm

ACUTE

acute relapse affecting function

ONGOING

relapsing-remitting MS

secondary progressive MS

primary progressive MS

Contributors

Authors

Mary Alissa Willis, MD

Associate Professor and Chair

Department of Neurology

University of Mississippi Medical Center

Jackson

MS

Disclosures

MAW has received payment for participating on the speakers' bureaus of Biogen, Genzyme, Novartis, and Genentech for speaking about multiple sclerosis. MAW also serves on the editorial board for the International Journal of MS Care.

Acknowledgements

Dr Mary Alissa Willis would like to gratefully acknowledge Dr Lael A. Stone, a previous contributor to this topic. We have since been made aware that Dr Stone is deceased.

Peer reviewers

Alex Rae-Grant, MD

Project Leader for Neurology

Neurological Institute

Cleveland Clinic

Cleveland

OH

Disclosures

ARG declares that he has no competing interests.

Sarah A. Morrow, MD, FRCPC, MS

Associate Professor of Neurology

Department of Clinical Neurological Sciences

London Health Sciences Centre

University Hospital

Ontario

Canada

Disclosures

SAM declares that she has no competing interests.

Marcelo Kremenchutzky, MD

Director

The London Multiple Sclerosis Clinic

Associate Professor

Schulich School of Medicine

University of Western Ontario

Neurologist

Clinical Neurological Sciences Department

University Hospital

London Health Sciences Centre

Ontario

Canada

Disclosures

MK declares that he has no competing interests.

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCPGlasg, FRCPLond

Consultant Neurologist

Department of Neurology

Queen’s Hospital

Romford

UK

Disclosures

AC declares that he has no competing interests.

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