Summary
Definition
History and exam
Key diagnostic factors
- visual disturbance in one eye
- peculiar sensory phenomena
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 disk or noncorrectable visual loss
- incorrect responses to Ishihara color blindness test plates
- abnormal eye movements
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
Diagnostic tests
1st tests to order
- MRI - brain
- MRI - spinal cord
- CBC
- comprehensive metabolic panel
- thyroid-stimulating hormone
- vitamin B12
Tests to consider
- antibody testing for neuromyelitis optica spectrum disorders (NMOSD)
- cerebrospinal fluid evaluation
- evoked potentials
Treatment algorithm
acute relapse affecting function
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 been compensated for Speakers' Bureau participation with Alexion, Biogen, Bristol-Myers Squibb, Genzyme, and Genentech, and advisory board participation with Alexion, Biogen, Greenwich Biosciences, Genentech, and Horizon.
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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