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Overview of Multiple Sclerosis

Overview of Multiple Sclerosis.  Valerie Robinson, D.O. . What is it?. Multiple sclerosis is an inflammatory demyelinating disease, likely auto-immune. Affects the CNS Causes multifocal areas of demyelination

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Overview of Multiple Sclerosis

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  1. Overview of Multiple Sclerosis Valerie Robinson, D.O.

  2. What is it? • Multiple sclerosis is an inflammatory demyelinating disease, likely auto-immune. • Affects the CNS • Causes multifocal areas of demyelination • Most commonly affects women of childbearing age who are of Northern European descent. • There is a multiple-gene component • Siblings 3-5%, Twins 20-40%

  3. Signs and Symptoms • Relapses and Remissions • Optic neuritis • Internuclear opthomoplegia • Sensory irregularities • Pain • Vertigo • Muscle weakness, spasticity, paraparesis or paraplegia • Bowel/bladder/sexual dysfunction

  4. Signs and Symptoms • Fatigue • Depression • Cognitive dysfunction • Difficulty with coordination • McDonald’s criteria • multiple lesions are separated in space and time • Uhthoff’s phenomenon • worsening of symptoms when the body temp increases • Lhermitte’s sign • feeling of electric shock running down back and limbs upon neck flexion

  5. Diagnosis • Clinical judgment confirmed by the following: • MRI shows demyelinated plaques that meet McDonald’s criteria • CSF analysis: increased IgG, oligoclonal bands • Abnormal evoked potentials (visual, somatosensory, and brainstem auditory) • Onset between age 15 and 50 • Before 16 is considered pediatric = 5%

  6. Exacerbations/Relapses Acute neurologic impairment causing loss of function or severe discomfort. • Pregnancy, particularly 2-3 months post-partum • Stress • Random

  7. Types of MS • Relapsing-remitting (RRMS): clear relapses with full or partial recovery. No progression between relapses. • Primary-progressive (PPMS): From onset, disease progresses with occasional plateaus and temporary minor improvements. • Secondary-progressive (SPMS): Onset as RRMS then begins to progress. With or without relapses, minor improvements and plateaus. • Progressive-relapsing (PRMS): From onset, disease progresses. It has occasional clear relapses with full or partial recovery. Progression continues between relapses.

  8. Differential • CVA/TIA • Malignancy • Spinal cord injury or compression • A-V malformations • Lupus • Sjogren’s • Cerebellitis • Infections: such as meningitis, human T-lymphocytic virus type 1, HIV, syphilis

  9. Treatment of Progressive • Immunosuppression • Azathioprine • Cladribine • Dalfampridine • Glucocorticoids •  Cyclophosphamide • Cyclosporine • Stem sell transplant • Glatiramer acetate • Interferon • Methotrexate • Mitoxantrone • Natalizumab • Rituximab • Total lymphoid irradiation

  10. Treatment of Relapsing • #1 Glucocorticoids • Interferon • Glatiramer acetate • Natalizumab • Plasma exchange if poor response to steroids • Methylprednisolone 1 gram IV QD x 3-7 days • Pediatric: 20-30 mg/kg QD x 5 days • May follow with a prednisone taper for residual disability

  11. References • Up-to-Date • Diagnosis of multiple sclerosis in adults • Epidemiology and clinical features of multiple sclerosis in adults • Treatment of progressive multiple sclerosis in adults • Treatment of acute exacerbations of multiple sclerosis in adults • Treatment of relapsing-remitting multiple sclerosis in adults • Treatment and prognosis of pediatric multiple sclerosis

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