Multiple sclerosis

Multiple sclerosis

• Multiple plaques of demyelination in the brain and spinal cord disseminated in time and place
• Clinical diagnosis: two neurological events separated in time and neurological location

Prevalence

• Increases moving north from the Equator
• 60-100 / 100000 in the UK

Aetiology

• Increased concordance among monozygotic twins
• HLA haplotype A3, B7, D2 and DR2 is more common
• Environmental
• ?Viral infection
• ?Dietary antigens

Pathology

• Plaques of demyelination particularly in
• Optic nerves
• Periventricular region
• Brainstem and cerebellar connections
• Cervical spinal cord
• Corticospinal tracts
• Posterior columns

Clinical patterns

• Relapsing/remitting
• Chronic progressive

Investigations

• Imaging
• MRI brain and spinal cord (visualises multiple plaques)
• CSF
• Oligoclonal bands in 80%
• Raised mononuclear cell count 5-60 cells /mm^3
• Visual evoked responses
• Delayed following optic neuropathy

Management

• No treatment has been shown to alter long-term outcome
• Corticosteroids - i.v. methylprednisolone or ACTH may speed recovery in acute relapses
• Beta-interferon - reduces relapse rate but not long-term outcome
• Physiotherapy
• Occupational therapy
• Walking aids
• Wheelchairs
• Car/house conversions
• Speech therapy
• Counselling

Prognosis

• Unpredictable course ranging from grave disability in mild and benign