Lenses, Crescents, Bleeds in the Head

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Multiple Sclerosis

• Jaimie Lynn Maines, MS-IV
• SYB 3
• 5 March 2008

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What is Multiple Sclerosis?

• Chronic, inflammatory, demyelinating disease that
  affects the CNS
• Onset usually in young adulthood
• Women gt men
• Affects neurons in white matter of brain and
  spinal cord
• Destroys oligodendrocytes ? loss of myelin sheath

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Signs and Symptoms

• Changes in sensation (hypoesthesia)
• Muscle weakness
• Abnormal muscle spasms
• Difficulty with movement
• Ataxia
• Dysarthria
• Dysphagia

• Nystagmus, optic neuritis, diplopia
• Fatigue and acute or chronic pain syndromes
• Bladder and bowel difficulties
• Cognitive impairment, depression
• Lhermittes Sign
• Classic finding in MS

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Disease Course and Clinical Subtypes

• Relapsing Form - new symptoms occur in discrete
  attacks
• Progressive Form - new symptoms slowly accumulate
  over time
• Relapse-Remitting Form - between attacks,
  symptoms resolve completely, but permanent
  neurological problems persist
• May develop Secondary Progressive MS

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Diagnosis

• Difficult to diagnose in early stages
• Definitive diagnosis cannot be made until other
  possible causes for symptoms have been ruled out
• In Relapsing-Remitting there must be evidence of
  at least 2 anatomically separate demyelinating
  events separated by at least 30 days
• In Primary Progressive there must be slow
  progression of si/sx over at least 6 months

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McDonald Criteria

• Clinical data alone - 2 separate episodes of
  neurologic symptoms characteristic of MS,
  consistent PE
• MRI - areas of demyelination appear as bright
  spots (active plaques enhance with Gad)
• CSF - evidence of chronic inflammation
• Oligoclonal bands combined with MRI and PE can
  make definitive diagnosis
• Visual or Somatosensory Evoked Potentials - brain
  with MS responds less actively to stimulation

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Imaging Studies

• MRI
• Test of choice to support clinical diagnosis
• Charactertistic lesion - cerebral or spinal
  plaque periventricular region, corpus callosum,
  centrum semiovale, deep white matter structures,
  basal ganglia
• Typically ovoid in appearance, arranged at right
  angles to corpus callosum
• Hyperintense on T2 MRI, hypointense on T1
• Diffusion imaging may identify plaques better
• Gad-enhancing plaques ? active lesions
• Discrete region of demyelination

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Differential Diagnosis

• Neuromyelitis Optica
• Autoimmune disease - attack of optic nerves and
  spinal cord
• Stroke
• Acute Disseminated Encephalomyelitis
• Immune mediated disease of brain following viral
  infection or vaccination multiple inflammatory
  cell deposits found in white matter
• Lyme Disease
• Tumors
• Lupus

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Medical Treatment

• There is NO cure
• Treatments aimed at returning function following
  an attack, preventing new attacks, and preventing
  disability
• IV steroids for acute attacks
• Interferon - disease modifying treatment
• Neurorehabilitation to ease burden of progressive
  impairment