summary Multiple Sclerosis is a chronic inflammatory disease caused by demyelination and widespread axonal injury in the central nervous system, leading to progressive motor and sensory dysfunction. Diagnosis is made with MRI with gadolinium of brain and spinal cord. Treatment is medical management with immunomodulators, antispasticity agents and physical therapy. Currently, there is no cure for the condition. Epidemiology Incidence 5 per 100,000 people in the US Demographics 20-40 years old women>men northern latitude Risk factors genetic not considered a hereditary disease environment stress smoking decreased sunlight/low vitamin D exposure Etiology Pathophysiology pathophysiology believed to be caused by a combination of genetic, environmental and infectious factors recent research suggests a T-cell mediated autoimmune mechanism Associated conditions orthopaedic increased fracture risk relating to increased risk of falling and decreased bone mineral density osteoporosis relating to physical inactivity, vitamin D deficiency, immunomodulatory medication gait abnormalities muscle paralysis causing foot drop, etc muscle and joint spasticity Presentation History clinically defined by two or more episodes of neurological dysfunction (brain, spinal cord or optic nerves) that are separated in time and space Symptoms symptoms of disease are based on the systems involved psych fatigue, depression, mood disorders central nervous system optic neuritis, diplopia, nystagmus ENT dysarthria, dysphagia MSK weakness, loss of balance and coordination, spasms, ataxia, falls neuro parasthesis, hypoesthesia, peculiar sensory phenomena's (e.g. sensation of wetness) GI incontinence, diarrhea, constipation urology incontinence, frequency, retention Physical exam inspection assess for gait abnormalities (e.g. wide-based gait, limb ataxia, slapping foot) joint or muscle contractures neurological examination muscle spasticity increased deep tendon reflexes muscle weakness Babinski positive special tests fundoscopy MLF syndrome (Internuclear Ophthalmoplegia) Lhermitte's sign Evaluation Laboratory studies CBC, lytes, TSH, comprehensive metabolic panel used to exclude concomitant illnesses usually normal CSF analysis mononucleur pleocytosis (25%) elevated CSF IgG (80%) oligoclonal bands on electrophoresis Imaging studies MRI indications obtain MRI with gadolinium of brain and spinal cord findings multiple focal demyelination scattered in brain and spinal cord asymmetric periventricular plaques Differential Cervical myelopathy, CNS mass lesion, vitamin B12 deficiency, sarcoidosis, CNS infections Treatment Nonoperative immunomodulators indications treatment attempt to return function after an attack, prevent new attacks, and prevent disability modalities corticosteroids indicated for acute exacerbations prophylactic immunosuppresants (interferon beta) may decrease the number and severity of relapses has been shown to decrease the progression of relapsing remitting multiple sclerosis antispasticity agents indications increased muscle tone with spasms modalities oral agents baclofen, gabapentin, clonazapem botox injections physiotherapy indications improve gait and balance modalities gentle stretching exercises for spasticity progressive resistant-training osteoporosis management Complications Increased fracture risk relating to increased risk of falling and decreased bone mineral density Osteoporosis relating to physical inactivity, vitamin D deficiency, immunomodulatory medication Prognosis Patterns of disease progression remitting-relapsing (most common) primary progressive secondary progressive progressive relapsing Life expectancy 5 to 10 years lower than that of unaffected people