Multiple sclerosis

Definition:

• Multiple Sclerosis (MS) is a chronic autoimmune, demyelinating disorder of the central nervous system (CNS) that can result in a wide range of neurological symptoms.

Epidemiology:

• More common in women.
• Typically diagnosed in young adults aged 20-40 years.

Etiology:

• The exact cause is unknown.
• Thought to involve an interplay of genetic susceptibility and environmental factors (e.g., viral infections, vitamin D deficiency).

Pathophysiology:

• Characterized by inflammation and demyelination in the CNS, leading to the formation of plaques or scars in the brain and spinal cord.
• These changes disrupt nerve signal transmission.

Types:

1. Relapsing-Remitting MS (RRMS):
   • Most common form. Characterized by distinct attacks of symptoms (relapses) followed by periods of partial or complete recovery (remissions).
2. Secondary Progressive MS (SPMS):
   • Initial relapsing-remitting course followed by progression with or without occasional relapses, minor remissions, and plateaus.
3. Primary Progressive MS (PPMS):
   • Steady worsening of disease from the onset without early relapses or remissions.
4. Progressive-Relapsing MS (PRMS):
   • Progressive from the onset, with clear acute relapses, with or without full recovery.

Clinical Features:

• Symptoms vary widely and can include visual disturbances, muscle weakness, coordination and balance problems, numbness, and cognitive changes.
• Fatigue is a common and debilitating symptom.

Diagnosis:

• MRI is the most sensitive tool for detecting CNS lesions typical of MS.
• Additional diagnostics: Lumbar puncture for CSF analysis, evoked potentials to assess nerve signal transmission.
• McDonald criteria used to integrate clinical and radiographic data for diagnosis.

Management:

• Disease-modifying therapies (DMTs) to reduce relapses and slow progression.
• Symptomatic treatments for fatigue, spasticity, pain, bladder and bowel problems, and cognitive issues.
• Multidisciplinary approach including physical therapy, occupational therapy, and cognitive rehabilitation.

Prognosis:

• Highly variable and unpredictable.
• Most people with MS do not become severely disabled, but can have a reduced quality of life.