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Multiple Sclerosis

 

Multiple sclerosis is a chronic inflammatory autoimmune disorder of the central nervous system: the most common cause of neurological disability in young adults.

The diagnosis depends on the detection of at least two demyelinating lesions in the brain or spinal cord separated in time and space. The course of the disease is characterised by relapses and remissions with some residual disability. Progressive disability may occur from the outset, but more commonly occurs after several years of relapsing and remitting disease.

  • classification of multiple sclerosis is important as all the disease modifying drugs have shown benefit only in the relapsing-remitting type and no benefit in the primary progressive form

Multiple sclerosis has a complex polygenic inheritance –family history important 

Clinical features of multiple sclerosis include:

  • optic neuritis usually unilateral
  • neurogenic bladder dysfunction
  • impotence
  • sensory deficits
  • upper motor neurone deficit:
    • most commonly a spastic weakness of the legs
  • cerebellar damage:
    • ataxia
    • dysarthria
    • nystagmus
  • vertigo is common
  • dementia in the later stages

Investigation in multiple sclerosis mostly Secondary care:

  • MRI scanning: visualisation of the dissemination of lesions in time and space
  • CSF and visual evoked potentials.

It is important not to immediately leap to a diagnosis of MS. The following should be considered:

  • a structural lesion should be excluded when disease is primarily unifocal, particularly when the lesion is in the spine
  • other diseases with relapsing and remitting course:
    • some cerebral tumours
    • Lyme disease
    • Sjogren's syndrome
    • Systemic lupus erythematosus
  • other causes of progressive spastic paraparesis:
    • vitamin B12 deficiency
    • HIV myelopathy
    • HTLV-1 associated myelopathy
  • other causes of visual loss:
    • neurosyphilis
    • vitamin B12 deficiency

 

 Referral: all patients with suspected new diagnosis of MS. If known MS and relevant problems, refer to MS nursing service. If acute disabling relapse and has previously responded to steroids consider single course of oral methyl prednisolone 500mg daily for 5 days, does not require tailing off.   (NICE + Gp notebook) 

The multiple sclerosis nurse is available on 01872 253063