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Home | Articles | Neurology | Multiple Sclerosis

Multiple Sclerosis

Last updated 29th February 2024

Epidemiology 

  1. Commoner in women than men, typically presenting between 20 and 40 years
  2. Prevalence 190/100,000 in Scotland

Three Main Types 

  1. Relapse-Remitting (RRMS) 85-90%
  2. Secondary progressive which occurs in 75% RRMS over 30 years
  3. Primary progressive 10-15%

Four Main Presentations 

  1. Optic Neuritis – pain with visual loss and normal looking optic disc. (patient sees nothing and doctor sees nothing)
  2. Brain stem demyelination – causes combinations of diplopia, vertigo, ataxia, dysarthria, plus pyramidal signs in limbs if long tracts involved
  3. Spinal cord lesions – spastic paraparesis with urinary and sensory symptoms which may be both positive (pins and needles and negative (numbness)
  4. Isolated monoparesis/hemiparesis – UMN signs often with sensory symptoms eg paraesthesias

Three Requirements for Diagnosis 

  1. Clinical – requires more than one attack affecting more than one part of the CNS ie lesions that are disseminated in time and space
  2. LP – positive oligoclonal bands (OCBS) present and increased lymphocyte count in CSF
  3. MRI – multiple periventricular plaques typically oval in shape and up to 2cm diameter

Management of Acute Relapse 

  1. Consult neurology team or MS Nurse (phone)
  2. Routine tests – FBC, U&E, BG, LFTs, calcium, CRP etc., check for infection
  3. Discuss with Neuromedics at WGH after hours if necessary
  4. If relapse (new or worsened neurological symptoms lasting for more than 24hours) administer 1g Methylprednisolone IV every day for 3 days
  5. If patient can not stay as inpatient alternatively 500 mg (5×100 mg) Methylprednislone (MEDRONE) orally every day for 5 days

Treatment

  1. Treatment has to be initiated by Neurologist as currently there are many treatments available for relapse remitting but also progressive disease. 

Content updated by Dr Ondrej Dolezal