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 login to view 1 more bullet environment login to view 3 more bullets Etiology Pathophysiology pathophysiology login to view 2 more bullets Associated conditions orthopaedic login to view 7 more bullets 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 login to view 14 more bullets Physical exam inspection login to view 2 more bullets neurological examination login to view 4 more bullets special tests login to view 3 more bullets Evaluation Laboratory studies CBC, lytes, TSH, comprehensive metabolic panel login to view 2 more bullets CSF analysis login to view 3 more bullets Imaging studies MRI login to view 5 more bullets Differential Cervical myelopathy, CNS mass lesion, vitamin B12 deficiency, sarcoidosis, CNS infections Treatment Nonoperative immunomodulators login to view 8 more bullets antispasticity agents login to view 6 more bullets physiotherapy login to view 5 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