Multiple Sclerosis



- See: EMG in Demyelinating Neuropathies:

- Discussion:
    - is a relapsing, and commonly progressive disorder of the white matter of the CNS;
    - is the most common demyelinating disease to affect the spinal cord and brain;
    - 80% of cases involve the cord, and 20-33% show symptoms referable to cord alone;
    - lesions may involve any region of cord, regardless of anatomy, although the cervical cord is involved more often;
    - often begins in early adulthood and has a variable prognosis:
            - 10 % of patients may do well for more than 20 years;
            - about 70 percent will have secondary progression;
            - one half will have difficulty walking after 15 yrs of dz;
    - initial clinical findings may include proprioceptive sensory loss and upper motor neuron signs;
    - other symptoms may include ataxia, tremor, or nystagmus;
    - MRI:
            - multifocal lesions of various ages
            - involvment of the periventricular white matter, brain stem, cerebellum, and spinal cord white matter;
            - presence of gadolinium-enhancing lesions indicates acute sites of inflammatory demyelination;
    - relapsing-remitting multiple sclerosis
            - this type present in 80 percent of MS patients
            - typically begins in the second or third decade of life
            - female predominance of approximately 2:1.
            - symptoms often progress over several days, the stabilize and may improve;
            - clinical findings:
                  - sensory disturbances;
                  - unilateral optic neuritis;
                  - diplopia (internuclear ophthalmoplegia);
                  - Lhermitte's sign
                  - limb weakness;
                  - clumsiness
                  - gait ataxia
                  - neurogenic bladder and bowel symptoms;
                  - onset of symptoms post partum
                  - Uhthoff's symptom: symptomatic worsening with increases in body temperature
                  - trigeminal neuralgia;
                  - episodic clumsiness;
                  - dysarthria;
                  - tonic limb posturing;
                  - aphasia
                  - recurrent seizures
                  - visual-field loss
                  - early dementia
                  - extrapyramidal phenomena (chorea and rigidity)
                  - cognitive impairment
                  - depression
                  - emotional lability
                  - dysarthria
                  - dysphagia
                  - vertigo
                  - progressive quadriparesis
                  - ataxic tremors
                  - pain
                  - sexual dysfunction
                  - spasticity
            - treatment:
                  - corticosteroids
                         - steroids may improve recovery but the effectiveness may diminish over time;
    - primary progressive MS:
            - 20 % of affected patients have primary progressive MS;
            - patients have a gradually progressive course;
            - similar incidence among men and women;
            - present with a slowly evolving upper-motor-neuron syndrome of the legs
            - worsens gradually with clinical findings:
                   - quadriparesis
                   - cognitive decline
                   - visual loss
                   - brain-stem syndromes
                   - sexual disfunction
                   - bladder and bowel dysfunction



Medical Progress: Multiple Sclerosis



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 23, 2012 9:26 am