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 login to view 1 more bullet osteoporosis login to view 1 more bullet gait abnormalities login to view 1 more bullet 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 login to view 1 more bullet central nervous system login to view 1 more bullet ENT login to view 1 more bullet MSK login to view 1 more bullet neuro login to view 1 more bullet GI login to view 1 more bullet urology login to view 1 more bullet 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 login to view 1 more bullet 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 login to view 1 more bullet findings login to view 2 more bullets Differential Cervical myelopathy, CNS mass lesion, vitamin B12 deficiency, sarcoidosis, CNS infections Treatment Nonoperative immunomodulators indications login to view 1 more bullet modalities login to view 5 more bullets antispasticity agents indications login to view 1 more bullet modalities login to view 3 more bullets physiotherapy indications login to view 1 more bullet modalities login to view 2 more bullets 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