Multiple Sclerosis

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Multiple Sclerosis

• Abdulelah Nuqali
• Intern

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What is Multiple Sclerosis?

• Multiple Sclerosis (MS) is an acquired
  inflammatory demyelinating disease of the CNS
  (brain and spinal cord).

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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

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What Causes MS?

• Unknown
• Genetics
• Environmental factors

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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?)

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Initial Presentation of MS
Incidence ()
Optic nerve inflammation 1429
Poor balance (ataxia) 218
Dizziness (vertigo) 29
Weakness 1040
Double visions (diplopia) 818
Bladder, bowel dysfunction 014
Pain 2140
Sensory loss 1339
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Other Common Symptoms of MS
Fatigue
Spasticity
Sexual dysfunction
Cognitive impairment Generally occurs later in the disease
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Multiple Sclerosis Clinical Subtypes
Lublin FD et al. Neurology. 199646907-911.
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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

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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

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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

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The 2010 McDonald Criteria for Diagnosis of MS
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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

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Treatment of New MS Exacerbations

• Drug therapy
• Corticosteroids
• Intravenous immunoglobulin
• Plasma exchange
• Physical therapy

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Prevention of Future Attacks and Disease
Progression

• Immune modulating drugs
• Beta-Interferon
• Glatiramer acetate
• Humanized monoclonal antibodies
• Immunosuppressant drugs
• Anti-cancer agents
• Combination therapies

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Symptom Management Examples
Symptom Drug
Spasticity Baclofen
Trigeminal neuralgia Dysethesias Carbamazepine
Bladder Hyperactivity Anti- Cholinergics ( oxybutynin )
Urinary retention Cholinergics ( Bethanechol )
Fatigue SSRI ( fluoxetine )
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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.