Table of Contents Types of MS Clinical features Investigations Management Acute relapsesPreventing relapses (disease-modifying agents)Symptomatic managementTry some questions Multiple sclerosis is a chronic inflammatory disorder characterised by plaques of demyelination in central nervous system that cause neurological symptoms and disability. Types of MS Relapsing-remitting (85%): intermittent relapses with subsequent total or partial recovery Primary progressive (15%): sustained, progressive disability from the start Secondary progressive: 65% of people with relapsing-remitting MS will develop secondary progressive MS with sustained, progressive disability Clinical features Any part of central nervous system can be affected but common deficits include: Optic nerve: reduced visual acuity, central scotoma Medial longitudinal fasciculus: internuclear ophthalmoplegia (disorder of lateral conjugate gaze) Cerebellum =DANISH: Dysdiadochokinesia Ataxia Nystagmus Intention tremor Speech abnormality (slurring/scanning/staccato) Hypotonia Spinal cord: spastic paraparesis, lower limb sensory loss, urinary symptoms Investigations Diagnosis requires demonstration of demyelinating lesions ‘disseminated in time and space’ MRI brain/spinal cord: shows demyelination Evoked potentials: may reveal delayed visual/auditory/sensory potentials due to demyelination Cerebrospinal fluid analysis: oligoclonal bands Management Management requires a multi-disciplinary approach (including neurologist, specialist nurse, physiotherapist, occupational therapist, GP, speech and language therapist) Acute relapses Methylprednisolone (IV or oral) Preventing relapses (disease-modifying agents) Suitable for some patients depending on type of MS: Monoclonal antibodies: alemtuzumab, natalizumab, ocrelizumab Oral therapies: sphingosine 1-phosphate receptor modulators (e.g. fingolimod, siponimod), teriflunomide, fumarates (e.g. diroximel fumarate, dimethyl fumarate) Platform injection therapies: glatiramer, β-interferon Symptomatic management Neuropathic pain: tricyclic antidepressants, gabapentin, pregabalin Incontinence: timed voiding, intermittent self-catheterisation for overflow, anticholinergics for urge Spasticity: physiotherapy, baclofen, gabapentin Oscillopsia: gabapentin Fatigue: exercise, diet, amantadine, modafinil, SSRI Reference: NICE ‘NG220 Multiple sclerosis in adults: management’ 2022 Try some questions What is oscillopsia? Oops! This section is restricted to members. Does multiple sclerosis cause upper or lower motor neuron lesions? Why? Oops! This section is restricted to members. What is Lhermitte’s sign? Oops! This section is restricted to members. What are the clinical findings of a internuclear ophthalmoplegia due to a right medial longitudinal fasciculus lesion? Oops! This section is restricted to members.