Multiple Sclerosis Aguide for parents: Current understanding, diagnosis and management

 

Multiple sclerosis (MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees and producing significant physical disability within 20-25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur months or years apart and affect different anatomic locations. See the image below.

Signs and symptoms

Classic MS signs and symptoms are as follows:

  • Sensory loss (ie, paresthesias): Usually an early complaint
  • Spinal cord symptoms (motor): Muscle cramping secondary to spasticity
  • Spinal cord symptoms (autonomic): Bladder, bowel, and sexual dysfunction
  • Cerebellar symptoms: Charcot triad of dysarthria, ataxia, and tremor
  • Optic neuritis
  • Trigeminal neuralgia: Bilateral facial weakness or trigeminal neuralgia
  • Facial myokymia (irregular twitching of the facial muscles): May also be a presenting symptom
  • Eye symptoms: Including diplopia on lateral gaze (33% of patients)
  • Heat intolerance
  • Constitutional symptoms: Especially fatigue (70% of cases) and dizziness
  • Pain: Occurs in 30-50% of patients at some point in their illness
  • Subjective cognitive difficulties: With regard to attention span, concentration, memory, and judgment
  • Depression: A common symptom
  • Euphoria: Less common than depression
  • Bipolar disorder or frank dementia: May be a late finding but is sometimes found at initial diagnosis
  • Symptoms associated with partial acute transverse myelitis

Treatment of MS has 2 aspects: immunomodulatory therapy (IMT) for the underlying immune disorder and therapies to relieve or modify symptoms.

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Treatment of acute relapses is as follows:

  • Methylprednisolone (Solu-Medrol) can hasten recovery from an acute exacerbation of MS
  • Plasma exchange (plasmapheresis) can be used short term for severe attacks if steroids are contraindicated or ineffective [5]
  • Dexamethasone is commonly used for acute transverse myelitis and acute disseminated encephalitis
  • http://emedicine.medscape.com/article/1146199-overview