Multiple Sclerosis
Multiple Sclerosis
SCLEROSIS
Multiple Sclerosis
Also known as MS
A chronic, inflammatory, immune-mediated disease of the central
nervous system (CNS).
The exact cause of MS remains unknown, it is believed to be a
complex interplay of genetic predisposition and environmental
factors.
In MS, the immune system attacks the protective sheath that
covers nerve fibers, known as myelin.
Eventually, the disease can cause permanent damage of the
nerve fibers. Disrupts nerve impulse transmission, resulting in a range
of neurological symptoms.
Signs and Symptoms Tremors and Coordination Problems
Fatigue Muscle Weakness and Spasticity
(Ataxia)
Biochemical Explanation: Biochemical Explanation:
Biochemical Explanation:
• Mitochondrial dysfunction in neurons leads to • Axonal conduction block in motor pathways
decreased ATP production.
• Lesions in the cerebellum and its
due to demyelination.
• Chronic inflammation and immune activation pathways impair motor control.
• Altered ion channel distribution causes
result in energy depletion and increased levels of • Myelin damage interferes with timing
hyperexcitability of motor neurons, leading to
pro-inflammatory cytokines (e.g., TNF-α, IL-1β), and precision of motor signals
spasticity.
which induce fatigue.
The type, duration, severity and impact of symptoms will vary from
individual to individual.
Prognostic Factors for
Multiple Sclerosis (MS):
Demographic factors: Age, gender, and ethnicity
Modifiable factors: Low vitamin D levels, smoking, and obesity
Co-morbidities: Hypertension, diabetes, and psychiatric
disorders
Clinical features: Higher relapse rate, especially early in the
disease course, relapse location in the brain or spinal cord, and
poor relapse recovery
Imaging biomarkers: High T2 lesions, spinal cord or infratentorial
lesions, T1 blackholes, and brain and spinal cord atrophy
Laboratory biomarkers: CSF oligoclonal bands
Favorable
Prognostic Factors:
Female
<40 years old when diagnosed
Few relapses in the first few years after diagnosis
Complete recovery from relapses
Long intervals between relapses
Symptoms: Sensory in nature (such as numbness
or tingling).
Poor
Prognostic Factors:
Male, Non-caucasian
Older age at onset
Motor or cerebellar signs at onset / Cognitive impairment
Short interval between first and second attacks
High relapse rate in the early years of the disease
Incomplete remission after first few relapses
Early disability
High lesion load on MRI scan
There is currently no cure for MS, but there are treatments that can help. The
best medicine for you depends on the symptoms and type of MS you have. Talk
to your neurologist about the right combination of treatments for you.
Treatment
1. Acute Treatment
a. For acute High Dose corticosteroids
exacerbations
First line of treatment
i. Very significant Examples: Methylprednisolone,
visual deficit Prednisone
ii. Extreme weakness Mechanism of action: Anti-inflammatory
iii. Any acute deficit of → glucocorticoids inhibit the release of
the symptoms cytokines and their effects
Treatment
1. Acute Treatment
a. For acute
exacerbations Plasmapheresis
i. Very significant Second line of treatment
visual deficit If the corticosteroids doesn’t work
ii. Extreme weakness Mechanism of action: Clears out
iii. Any acute deficit of
the antibodies from the plasma
the symptoms
Treatment
2. Supportive Therapy
a. Spasticity in UMNL (Upper Motor
Neuron Lesion)
-Antispasmodic agents
b. Paresthesia (dorsal column and
spinothalamic tract infection)
Gabapentin
Pregabalin
Tricyclic antidepressant
Other Regular exercise can
improve a wide range of
treatments symptoms
the results
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