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Multiple sclerosis


Learning objectives

  • Learning
  • Understand
  • Integrate
  • Reflect

Introduction
  • Inflammatory condition of brain and spinal cord that damages myelin
  • Can mimic stroke and so should be identifiable
Aetiology
  • Dysregulated immune system
  • Autoimmune nature of MS has long been suspected.
  • Inflammation and demyelination in the CNS
  • Oligoclonal bands in the CSF
Clinical
  • Clinically isolated syndromes
  • Double vision, loss of vision in one eye due to optic neuritis
  • Weakness due to involvement of long tracts
  • Sensory loss due to involvement of sensory pathways
  • Ataxia due to cerebellar involvement
  • MS is typically a chronic relapsing and remitting disease of young adults.
  • Lesions separated in time and space without fever or viral illness
Investigations
  • FBC, U&E, LFT, CRP, ESR
  • CT: may show white matter hypodensity
  • CSF: oligoclonal bands. Raised protein,
  • MRI scan: multiple lesions and involves brain and cervical spine
  • LP: raised protein and slight increase in WCC in 30%.Protein > 100mg/dl. No oligoclonal bands
Differentials
  • Acute Disseminated Encephalomyelitis
  • Susac syndrome
  • Progressive multifocal leukoencephalopathy
Management
  • Support, diagnosis and rehabilitation as needed
  • Treat acute relapse with Methylprednisolone for disabling motor or sensory/visual relapses
  • NICE recommend oral methylprednisolone 0.5 g daily for 5 days and IV methylprednisolone 1 g daily for 3-5 days as an alternative or in those whom oral steroids have failed or not been tolerated.
References and further reading