Multiple Sclerosis A chronic, progressive central nervous system disease with a disseminating demyelination of the nerve fibers of the brain and spinal cord characterized by exacerbation and remission of varied multiple neurological symptoms.

Etiology I. Genetic susceptibility I. Genetic susceptibility II. Environmental factors II. Environmental factors 1. Infections 1. Infections 2. Geographical 2. Geographical 3. Toxic 3. Toxic 4. Social conditions 4. Social conditions 5. Diet 5. Diet 6. Other factors (trauma) 6. Other factors (trauma)

Disease Process Multifocal plaques of demyelination form continuously and are distributed randomly throughout the white matter of the central nervous system Multifocal plaques of demyelination form continuously and are distributed randomly throughout the white matter of the central nervous system As myelin breakdown continues, lipid byproducts undergo phagocytosis, and the myelin sheath is destroyed As myelin breakdown continues, lipid byproducts undergo phagocytosis, and the myelin sheath is destroyed This leads to a decrease in velocity and blockage of nerve conduction, and interference with or failure of impulse transmissions This leads to a decrease in velocity and blockage of nerve conduction, and interference with or failure of impulse transmissions Astrocytic processes proliferate, transforming older lesions into glial scars. The scars stop the inflammation and edema of the lesion, leading to remission early in the disease process Astrocytic processes proliferate, transforming older lesions into glial scars. The scars stop the inflammation and edema of the lesion, leading to remission early in the disease process As the disease progresses, symptoms become permanent. As the disease progresses, symptoms become permanent.

Symptoms Early The onset is generally insidious and symptoms are transient, beginning with paresthesias in extremities, trunk, or face; clumsiness and muscle weakness; transient visual disturbances and optic pain; ataxia; bladder incontinence; and vertigo The onset is generally insidious and symptoms are transient, beginning with paresthesias in extremities, trunk, or face; clumsiness and muscle weakness; transient visual disturbances and optic pain; ataxia; bladder incontinence; and vertigoMidcourse Emotional lability, apathy, shortened attention span; seizures; diplopia; dysarthria; static tremor; spasticity, gait disturbances; transient bowel incontinence Emotional lability, apathy, shortened attention span; seizures; diplopia; dysarthria; static tremor; spasticity, gait disturbances; transient bowel incontinenceLate Dementia; scanning speech; nystagmus; intention tremor; hemiplegia; generalized muscular weakness and atrophy; inability to stand and walk; loss of bowel and bladder control Dementia; scanning speech; nystagmus; intention tremor; hemiplegia; generalized muscular weakness and atrophy; inability to stand and walk; loss of bowel and bladder control

Potential Complications Some individuals have frequent attacks, leading to rapid incapacitation with an unremitting, progressive course that ends in death within 1 to 2 years. Some individuals have frequent attacks, leading to rapid incapacitation with an unremitting, progressive course that ends in death within 1 to 2 years. Others are prone to complications related to progressive disease and disuse syndrome, such as pressure sores, contractures, pathologic fractures, pneumonia, renal infection, and septicemia Others are prone to complications related to progressive disease and disuse syndrome, such as pressure sores, contractures, pathologic fractures, pneumonia, renal infection, and septicemia Death usually is caused by complications rather than the primary disease. Death usually is caused by complications rather than the primary disease.

Diagnostic Tests elevated cerebrospinal fluid (CSF) IgG coupled with normal serum IgG elevated cerebrospinal fluid (CSF) IgG coupled with normal serum IgG normal CSF protein normal CSF protein slowed nerve conduction in evoked potential studies slowed nerve conduction in evoked potential studies computed tomography computed tomography magnetic resonance imaging scans of lesions magnetic resonance imaging scans of lesions

Treatments Surgery Surgery Drugs Drugs General General