Multiple sclerosis (MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees and producing significant physical disability within 20-25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur months or years apart and affect different anatomic locations.
Multiple sclerosis (MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees and producing significant physical disability within 20-25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur months or years apart and affect different anatomic locations.
Signs and symptoms
Classic MS signs and symptoms are as follows:
• Sensory loss (ie, paresthesias): Usually an early complaint
• Spinal cord symptoms (motor): Muscle cramping secondary to spasticity
• Spinal cord symptoms (autonomic): Bladder, bowel, and sexual dysfunction
• Cerebellar symptoms: Charcot triad of dysarthria, ataxia, and tremor
• Optic neuritis
• Trigeminal neuralgia: Bilateral facial weakness or trigeminal neuralgia
• Facial myokymia (irregular twitching of the facial muscles): May also be a presenting symptom
• Eye symptoms: Including diplopia on lateral gaze (33% of patients)
• Heat intolerance
• Constitutional symptoms: Especially fatigue (70% of cases) and dizziness
• Pain: Occurs in 30-50% of patients at some point in their illness
• Subjective cognitive difficulties: With regard to attention span, concentration, memory, and judgment
• Depression: A common symptom
• Euphoria: Less common than depression
• Bipolar disorder or frank dementia: May be a late finding but is sometimes found at initial diagnosis
• Symptoms associated with partial acute transverse myelitis
Diagnosis
MS is diagnosed on the basis of clinical findings and supporting evidence from ancillary tests. Tests include the following:
• Magnetic resonance imaging: The imaging procedure of choice for confirming MS and monitoring disease progression in the CNS
• Evoked potentials: Used to identify subclinical lesions; results are not specific for MS
• Lumbar puncture: May be useful if MRI is unavailable or MRI findings are nondiagnostic; CSF is evaluated for oligoclonal bands and intrathecal immunoglobulin G (IgG) production
Classification
MS is divided into the following categories, principally on the basis of clinical criteria, including the frequency of clinical relapses, time to disease progression, and lesion development on MRI[1, 2, 3, 4]:
• Relapsing-remitting MS (RRMS): Approximately 85% of cases
• Secondary progressive MS (SPMS)
• Primary progressive MS (PPMS)
• Progressive-relapsing MS (PRMS)
The following 2 subgroups are sometimes included in RRMS:
• Clinically isolated syndrome (CIS): A single episode of neurologic symptoms
• Benign MS: MS with almost complete remission between relapses and little if any accumulation of physical disability over time.
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