Multiple Sclerosis
Abdulelah NuqaliIntern
What is Multiple Sclerosis?
• Multiple Sclerosis (MS) is an acquired inflammatory demyelinating disease of the CNS (brain and spinal cord).
MS is a Demyelinating Disease
Myelin – provides insulation to nerve processes (axons)
Blood vessel
Blood vessel
Blood vessel
Inflammation
Inflammation
Inflammation
Myelin – provides insulation to nerve processes (axons)
Blood vessel
Blood vessel
Blood vessel
Blood vessel
Blood vessel
Blood vessel
Inflammation
Inflammation
Inflammation
Inflammation
Inflammation
Inflammation
How Common is MS and Who Gets It?
• 8,000 – 10,000 new cases are diagnosed annually• Affects nearly 500,000 individuals in the U.S.• Occurs most frequently between ages 25 - 35• Affects women 2 to 3 times as often as men• More frequent in populations native to areas further
away from the equator• Prevalence of MS in KSA is 4-8 cases per 100,000
What Causes MS?
• Unknown• Genetics• Environmental factors
Not Everyone with a Genetic Risk Will Develop MS – Why?
• Risk is modified by Environmental factors– Sunlight– Diet (e.g., vitamin D)– Other lifetime experiences (infections?)
Initial Presentation of MS
Incidence (%)
Optic nerve inflammation 14–29
Poor balance (ataxia) 2–18
Dizziness (vertigo) 2–9
Weakness 10–40
Double visions (diplopia) 8–18
Bladder, bowel dysfunction 0–14
Pain 21–40
Sensory loss 13–39
Other Common Symptoms of MS
•Fatigue•Spasticity•Sexual dysfunction•Cognitive impairment
–Generally occurs later in the disease
Multiple Sclerosis Clinical SubtypesMultiple Sclerosis Clinical Subtypes
Lublin FD et al. Neurology. 1996;46:907-911.
Relapsing-remitting
Primary-progressive
Dis
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Time
Time
Dis
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tySecondary-progressive
Progressive-relapsing
Time
Time
Dis
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isab
ility
How Is MS Diagnosed?
• At least two episodes of symptoms – Occur at different points in time (DIT)– Result from involvement of different areas of
the central nervous system (DIS)
• Absence of other treatable causes for the symptoms
• Results of neurological testing
Examples of MS Onset• Case 1: 26 year old woman
– Decreased vision in the right eye in 9/05– Left leg numbness in 1/06– Right face numbness, right arm and leg weakness in 4/06 – Left leg weakness in 8/06
• Case 2: 45 year old man– Left arm weakness in 2/93– Numbness below the waist in 4/07
How Is MS Diagnosed?
Magnetic resonance imaging (MRI)CSF :• slight mononuclear pleocytosis or elevated in
protein• Increase IgG ( elevated IgG index OR the
presence of oligoclonal IgG bands )Visual evoked potentials
Magnetic Resonance Imaging in MS
Spinal cordOptic nerve
Brain
Spinal cordSpinal cordOptic nerveOptic nerve
BrainBrain
The 2010 McDonald Criteria for Diagnosis of MS
How is MS Treated and Managed?
• Drug therapy– Treat new attacks (exacerbations)– Prevent the occurrence of future attacks– Slow or prevent disease progression– Treat the chronic symptoms of the disease
• Physical therapy• Psychosocial support
Treatment of New MS Exacerbations
• Drug therapy– Corticosteroids– Intravenous immunoglobulin– Plasma exchange
• Physical therapy
Prevention of Future Attacks and Disease Progression
• Immune modulating drugs– Beta-Interferon– Glatiramer acetate– Humanized monoclonal antibodies
• Immunosuppressant drugs– Anti-cancer agents
• Combination therapies
Symptom Management – Examples
Symptom DrugSpasticity Baclofen
Trigeminal neuralgia & Dysethesias
Carbamazepine
Bladder Hyperactivity Anti- Cholinergics ( oxybutynin )
Urinary retention Cholinergics ( Bethanechol )
Fatigue SSRI ( fluoxetine )
Summary• MS is a common inflammatory disease of the CNS
that affects females more frequently than males.• The cause of MS appears to be a combination of
genetic and environmental factors.• The symptoms of MS can be quite variable.• MRI is a sensitive test for making the diagnosis of
MS.• Treatments are available for reducing the number of
MS attacks and for slowing MS disease progression.
