Epidemiology
- Geography: more common in temperate climates
- Age of Onset: 15-60 y/o
- Sex
- Familial Cases
Diagnosis
Complete Blood Count (CBC) (see Complete Blood Count, [[Complete Blood Count]])
- xxx
Brain Magnetic Resonance Imaging (MRI) (see Magnetic Resonance Imaging, [[Magnetic Resonance Imaging]])
- Demyelination/Plaques
Spine Magnetic Resonance Imaging (MRI) (see Magnetic Resonance Imaging, [[Magnetic Resonance Imaging]])
- Demyelination/Plaques
Lumbar Puncture (see Lumbar Puncture, [[Lumbar Puncture]])
- Total Protein: elevated
- Cell Count
- Pleocytosis: 25% of cases have WBC >5 per µL (with mononuclear predominance)
- WBC >50 per µL is unusual, but may occur at onset of disease
- WBC >75 per µL makes MS diagnosis unlikely
- Pleocytosis: 25% of cases have WBC >5 per µL (with mononuclear predominance)
- Oligoclonal IgG Banding: present in XXX
Electromyogram (EMG)/Nerve Conduction Velocity (NCV) (see xxxxx, [[xxxx]])
- xxx
Clinical Manifestations
General Comments
Clinical Features Which are Suggestive of Multiple Sclerosis
- Chronology: relapses and/or remissions
- Onset: between age 15-50 y/o
- Clinical Features: polysymptomatic onset occurs in 14% of cases
- Fatigue (see Fatigue, [[Fatigue]])
- Heat Sensitivity (Uhthoff Phenomenon)
- Internuclear Ophthalmoplegia (see Internuclear Ophthalmoplegia, [[Internuclear Ophthalmoplegia]])
- Lhermitte Sign (see Lhermitte Sign, [[Lhermitte Sign]]): present in 2% of cases
- Electric shock-like sensations that run down the back and/or limbs upon neck flexion
- Optic Neuritis (see Optic Neuritis, [[Optic Neuritis]])
Clinical Features Which are Atypical of Multiple Sclerosis
- Chronology: gradual progression
- Onset: before 10 y/o and after 50 y/o
- Clinical Features
Neurologic Manifestations
Brainstem Symptoms
- Internuclear Ophthalmoplegia (see Internuclear Ophthalmoplegia, [[Internuclear Ophthalmoplegia]])
- Trigeminal Neuralgia (see Trigeminal Neuralgia, [[Trigeminal Neuralgia]]): facial sensory symptoms are present in 3% of cases
- Trigeminal neuralgia in a young adult may be an early sign of MS
Cortical Symptoms
- General Comments: much less common in MS
- Aphasia (see Aphasia, [[Aphasia]])
- Visual Field Disturbances
Long Tract Symptoms
- Brown-Sequard Syndrome (see Brown-Sequard Syndrome, [[Brown-Sequard Syndrome]])
- xxx
- Numbness (see xxxx, [[xxxx]])
- Sensory Symptoms in Extremities: present in 31% of cases (sensory symptoms are the most common initial feature of MS)
- Parasthesias (see Parasthesias, [[Parasthesias]])
- Sensory Symptoms in Extremities: present in 31% of MS cases sensory symptoms are the most common initial feature of MS)
- Weakness (see xxxx, [[xxxx]])
- Acute Motor Symptoms: present in 4% of cases
- Subacute Motor Symptoms: present in 9% of cases
Spinal Cord Symptoms
- Transverse Myelitis (see Transverse Myelitis, [[Transverse Myelitis]]): present in 1% of cases
Ophthalmologic Manifestations
Diplopia (see Diplopia, [[Diplopia]])
- Epidemiology: present in 7% of MS cases
Optic Neuritis (see Optic Neuritis, [[Optic Neuritis]])
- Epidemiology
- Clinical
- Acute/Subacute Unilateral Eye Pain (see Eye Pain, [[Eye Pain]]): accentuated by eye movements
- Afferent Pupillary Defect (Marcus-Gunn Pupil) (see Marcus-Gunn Pupil, [[Marcus-Gunn Pupil]])
- Desaturation of Bright Colors (Particularly Red): often reported following episode of optic neuritis
- Visual Loss (Scotoma): present in 16% of MS cases
- Prognosis: 90% of cases regain normal version over 2-6 mo after an acute optic neuritis episode
Pulmonary Manifestations
Respiratory Failure (see Respiratory Failure, [[Respiratory Failure]])
- xxx
Clinical courses:
-Acute MS (Malignant Monophasic MS/ Marburg Disease): rare variant with fulminant disease, which may be rapidly fatal
-Relapsing MS:
-Chronic, progressive MS:
-Inactive MS:
Symptoms:
-Weakness (35%):
-Sensory loss (37%):
-Parasthesias (24%):
-Visual symptoms due to optic neuritis (36%):
-Diplopia (15%):
-Ataxia (11%):
-Vertigo (6%):
-Lhermitte sign (3%):
- Acute/Chronic Hypoventilation
Treatment
Supportive Care
Mechanical Ventilation
- Rocking Bed
- Positive Pressure Ventilation
Immunotherapies
Glatiramer Acetate (Copaxone) (see Glatiramer Acetate, [[Glatiramer Acetate]])
- xxx
Interferon Beta-1a (Avonex, CinnoVex, Rebif) (see Interferon Beta-1a, [[Interferon Beta-1a]])
- xxx
Interferon Beta-1b (Betaseron, Betaferon) (se Interferon Beta-1b, [[Interferon Beta-1b]])
- xxxx
Dimethyl Fumarate (Tecfidera) (see Dimethyl Fumarate, [[Dimethyl Fumarate]])
- xxx
Fingolimod (Gilenya) (see Fingolimod, [[Fingolimod]])
- xxx
Mitoxantrone (see Mitoxantrone, [[Mitoxantrone]])
- xxx
Natalizumab (Tysabri) (see Natalizumab, [[Natalizumab]])
- xxxx
Teriflunomide (Aubagio) (see Teriflunomide, [[Teriflunomide]])
- xxx
Corticosteroids (see Corticosteroids, [[Corticosteroids]])
Indications
- xxx
Adverse Effects
- Arrhythmias: smokers or patients with autonomic disturbances (such as sphincter and bowel problems) have increased risk of developing arrhythmias while receiving high dose corticosteroids for multiple sclerosis
- Atrial Fibrillation (see Atrial Fibrillation, [[Atrial Fibrillation]])
- Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]])
- Sinus Tachycardia (see Sinus Tachycardia, [[Sinus Tachycardia]])
- Ventricular Tachycardia (see Ventricular Tachycardia, [[Ventricular Tachycardia]])
Plasmapheresis (see Plasmapheresis, [[Plasmapheresis]]))
- May Be Useful for Acute Multiple Sclerosis
Phrenic Nerve Pacing
- xxxx
References
- Incidence of various cardiac arrhythmias and conduction disturbances due to high dose intravenous methylprednisolone in patients with multiple sclerosis. J Neurol Sci. 2011 Oct 15;309(1-2):75-8. doi: 10.1016/j.jns.2011.07.018. Epub 2011 Aug 9 [MEDLINE]