{"id":114,"date":"2013-03-15T20:48:28","date_gmt":"2013-03-15T20:48:28","guid":{"rendered":"https:\/\/docneuro.jz7sunfr-liquidwebsites.com\/multiple-sclerosis\/"},"modified":"2019-12-30T22:18:25","modified_gmt":"2019-12-30T22:18:25","slug":"multiple-sclerosis","status":"publish","type":"post","link":"https:\/\/docneuro.com\/multiple-sclerosis\/","title":{"rendered":"Multiple Sclerosis"},"content":{"rendered":"

MULTIPLE SCLEROSIS is aptly named for the scleroses (scars or\u00a0plaques) that occur as the disease resurfaces in multiple episodes.<\/p>\n

<\/p>\n

Diagnosis of multiple sclerosis – the 2010 update<\/h3>\n

The McDonald Criteria for diagnosing MS was updated\u00a0in 2010 to help simplify the use of images, and in cases, use one MRI\u00a0to establish dissemination in space and time and allow for earlier\u00a0diagnosis. In those criteria, the gold standard remains 2+ attacks =\u00a0clinical evidence of 2+ lesions = 1 lesion + 1 episode by reliable\u00a0history, but the presence of both gadolinium-enhancing and\u00a0non-enhancing lesions on baseline MRI can substitute for a follow-up\u00a0scan as long as the enhancing lesion is not due to a non-MS pathology.\u00a0Gad-enhancing lesions in multiple sclerosis represent disease activity\u00a0usually of up to 6 months; by contrast, T2 lesions represent older,\u00a0scarred areas. See Figure 1.<\/p>\n

\"Dawson's<\/p>\n

Figure 1:<\/strong>\u00a0<\/em>A.\u00a0<\/em>Dawson’s fingers<\/a> on sagittal FLAIR image. B. GAD-enhancing lesions on axial T1 image.<\/em><\/p>\n

Pathophysiology of multiple sclerosis<\/h3>\n

The immune system attacks the central nervous system.\u00a0As specific targets of immune attack in MS not identified, MS is an\u00a0immune-mediated disease. \u00a0The immune attack damages myelin, which in\u00a0turn forms scars.<\/p>\n

Epidemiology of MS<\/h3>\n

With the caveat that misdiagnosis is common, worldwide\u00a0over 2 million people are affected according to the National MS\u00a0Society as of 2013. As is common in immune-mediated diseases, MS has a\u00a02-fold female predilection. Although can occur in any age, it is\u00a0usually diagnosed around ages 15-50. Family history and living at\u00a0northern latitudes are associated risk factors.<\/p>\n

Clinical features of MS<\/h3>\n

Initial symptoms include changes in sensation,\u00a0strength, vision, gait, dexterity, coordination, balance, and\u00a0sphincter function. Nonspecific heralding symptoms include malaise,\u00a0fatigue, and headache. CNS plaques on MRI and lumbar puncture\u00a0demonstrating oligoclonal bands and increased IgG antibodies are\u00a0diagnostic.<\/p>\n

Clinical Course of MS<\/h3>\n

Four subtypes of MS have been classified:\u00a0fortunately, the initial course of most patients with MS is\u00a0relapsing-remitting.\u00a0Along with the initial presenting symptoms, patients also suffer from\u00a0muscle spasticity, pain, as well as urinary and sexual dysfunction. See Figure 2.<\/p>\n

No cure for MS exists, however current treatments reduce symptoms and\u00a0disability.<\/p>\n

\"Multiple
Figure 2:<\/strong> The clinical course defining four subtypes of multiple sclerosis – progressive-relapsing MS, secondary progressive MS, primary progressive MS, and relapsing-remitting MS<\/em><\/p>\n

The key immune-mediated disease modifying treatments for\u00a0relapsing-remitting MS of historical and contemporary relevance\u00a0include interferons, glatiramer acetate, mitoxantrone, nataluzimab,\u00a0teriflunomide, fingolimod, and dimethyl fumarate (BG-12). Additional\u00a0therapies are also currently undergoing clinical trials. Most patients\u00a0are also on an anti-spasmodic, as well as analgesic for neuropathic\u00a0pain.<\/p>\n

Devic\u2019s disease, also known as Neuromyelitis optica (NMO) as an\u00a0important variant which consists of simultaneous optic neuritis and\u00a0myelitis (inflammation and demyelination of the spinal cord). MRI\u00a0lesions may be found in the spinal cord, but patients can have a\u00a0normal brain MRI. It is associated with serum aquaporin 4\u00a0autoantibodies and poor response to some standard MS treatments.<\/p>\n

References:<\/h3>\n
    \n
  1. Cree AC. \u201cDiagnosis and differential diagnosis of multilple\u00a0sclerosis.\u201d Continuum Lifelong Learning Neurol. 2010 16 (5): 19-36.<\/li>\n
  2. He et al. \u201cEnhancing Patterns in Multiple Sclerosis: Evolution and\u00a0Persistence.\u201d AJNR Am J Neuroradiology. 22:664\u2013669, April 2001.<\/li>\n
  3. Heun R, Kappos L, Bittkau S, et al. Magnetic resonance imaging and\u00a0early diagnosis of MS. Lancet 1988;2:1202\u20131203.<\/li>\n
  4. Barkhof F, van Walderveen MA, et al. The effect of gadolinium on the\u00a0sensitivity and specificity of MR in the initial diagnosis of multiple\u00a0sclerosis. Am J Neuroradiol. 1995;16:259\u2013264.<\/li>\n
  5. Multiple Sclerosis Association of America<\/a>. \u201cSymptom Management.\u201d<\/li>\n
  6. National Multiple Sclerosis Society<\/a>. \u201cWhat is Multiple Sclerosis?\u201d<\/li>\n
  7. Polman et al. \u201cDiagnostic criteria for multiple sclerosis: 2010\u00a0Revisions to McDonald Criteria. Annals of Neurology. 69(2) Wiley.\u00a0pp292-302. 2011.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    MULTIPLE SCLEROSIS is aptly named for the scleroses (scars or\u00a0plaques) that occur as the disease resurfaces in multiple episodes.<\/p>\n","protected":false},"author":6,"featured_media":433,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[9],"tags":[75,72,73,316,318,317],"aioseo_notices":[],"yoast_head":"\nMultiple Sclerosis - DocNeuro<\/title>\n<meta name=\"description\" content=\"Clinical presentation and pathophysiology of multiple sclerosis.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/docneuro.com\/multiple-sclerosis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Multiple Sclerosis - 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