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
• 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%
Signs and Symptoms
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Relapses and Remissions
Optic neuritis
Internuclear opthomoplegia
Sensory irregularities
Pain
Vertigo
Muscle weakness, spasticity, paraparesis or
paraplegia
• Bowel/bladder/sexual dysfunction
Signs and Symptoms
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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
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%
Exacerbations/Relapses
Acute neurologic impairment causing loss of
function or severe discomfort.
• Pregnancy, particularly 2-3 months postpartum
• Stress
• Random
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.
Differential
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CVA/TIA
Malignancy
Spinal cord injury or compression
A-V malformations
Lupus
Sjogren’s
Cerebellitis
Infections: such as meningitis, human Tlymphocytic virus type 1, HIV, syphilis
Treatment of Progressive
• Immunosuppression
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Azathioprine
Cladribine
Dalfampridine
Glucocorticoids
 Cyclophosphamide
Cyclosporine
• Stem sell transplant
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Glatiramer acetate
Interferon
Methotrexate
Mitoxantrone
Natalizumab
Rituximab
• Total lymphoid irradiation
Treatment of Relapsing
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#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
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