Highlights & Basics
- Multiple sclerosis (MS) is a demyelinating central nervous system condition clinically defined by two episodes of neurologic dysfunction (brain, spinal cord, or optic nerves) that are separated in space and time.
- Classically presents in white women, ages between 20 and 40 years, with temporary visual or sensory loss. However, it may affect either sex and any age or ethnic group, and may have variable neurologic symptom location and/or duration.
- The patient may have subtle changes in vision, ambulation, and reflexes on examination that provide evidence of previous attacks (which may not have been noticed by the patient).
- Magnetic resonance imaging (MRI) of both the brain and spinal cord is important in diagnosis. Brain MRI is sensitive, but very susceptible to over-interpretation in the absence of clinical correlation. Spinal cord MRI is abnormal less often, but lends greater specificity when present with brain lesions.
- Treatment of MS can be divided into three parts: treatment of the acute attack; prevention of future attacks by reducing triggers and use of disease-modifying therapies; and symptomatic treatments of neurologic difficulties such as spasticity, pain, fatigue, and bladder dysfunction.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Cervical spine magnetic resonance imaging scan illustrating neuromyelitis optica spectrum disorder. Extensive multiple levels of cervical spinal cord involvement with edema and blood-brain barrier breakdown as illustrated by the contrast-enhanced T1-weighted image (left). The T2-weighted image (right) indicates the extent of signal abnormality that may manifest clinically as quadriparesis with severe spasticity and pain
Representative axial magnetic resonance images using fluid-attenuated inversion recovery (FLAIR) showing typical lesions seen in MS in the periventricular regions. Comparable slices using the contrast agent gadolinium illustrate blood-brain barrier breakdown/active inflammation in 2 of the lesions. The FLAIR lesions that do not enhance are likely to be older, with a combination of gliosis and low-level chronic inflammation and degeneration
Sagittal fluid-attenuated inversion recovery (FLAIR) images with typical MS lesions involve the corpus callosum either as discrete lesions or as finger-like projections perpendicular to the corpus callosum. Note also the enlargement of the ventricles and diffuse atrophy of more advanced MS
Magnetic resonance imaging scan of the cervical spine at high (≥1 Tesla) magnetic field strength illustrating a lesion that may cause myelopathic symptoms of bowel and bladder dysfunction, as well as spastic paraparesis
Citations
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Scolding N, Barnes D, Cader S, et al. Association of British Neurologists: revised (2015) guidelines for prescribing disease-modifying treatments in multiple sclerosis. Pract Neurol. 2015 Aug;15(4):273-9.[Abstract][Full Text]
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