Multiple Multiple SclerosisSclerosis

A chronic, progressive central nervous A chronic, progressive central nervous system disease with a disseminating system disease with a disseminating

demyelination of the nerve fibers of the demyelination of the nerve fibers of the brain and spinal cord characterized by brain and spinal cord characterized by exacerbation and remission of varied exacerbation and remission of varied

multiple neurological symptoms.multiple neurological symptoms.

EtiologyEtiology

I.I.  Genetic susceptibilityGenetic susceptibility II.II.  Environmental factorsEnvironmental factors 1.1.  Infections Infections 2.2.  Geographical Geographical 3.3.  Toxic Toxic 4.4.  Social conditionsSocial conditions 5.5.  Diet Diet 6.6.  Other factors (trauma) Other factors (trauma)

Disease ProcessDisease Process Multifocal plaques of demyelination form continuously and Multifocal plaques of demyelination form continuously and

are distributed randomly throughout the white matter of are distributed randomly throughout the white matter of the central nervous systemthe central nervous system

As myelin breakdown continues, lipid byproducts undergo As myelin breakdown continues, lipid byproducts undergo phagocytosis, and the myelin sheath is destroyedphagocytosis, and the myelin sheath is destroyed

This leads to a decrease in velocity and blockage of nerve This leads to a decrease in velocity and blockage of nerve conduction, and interference with or failure of impulse conduction, and interference with or failure of impulse transmissionstransmissions

Astrocytic processes proliferate, transforming older Astrocytic processes proliferate, transforming older lesions into glial scars. The scars stop the inflammation lesions into glial scars. The scars stop the inflammation and edema of the lesion, leading to remission early in the and edema of the lesion, leading to remission early in the disease processdisease process

As the disease progresses, symptoms become permanent. As the disease progresses, symptoms become permanent.

SymptomsSymptoms Early Early The onset is generally insidious and symptoms are The onset is generally insidious and symptoms are

transient, beginning with paresthesias in extremities, transient, beginning with paresthesias in extremities, trunk, or face; clumsiness and muscle weakness; transient trunk, or face; clumsiness and muscle weakness; transient visual disturbances and optic pain; ataxia; bladder visual disturbances and optic pain; ataxia; bladder incontinence; and vertigo incontinence; and vertigo

Midcourse Midcourse Emotional lability, apathy, shortened attention span; Emotional lability, apathy, shortened attention span;

seizures; diplopia; dysarthria; static tremor; spasticity, gait seizures; diplopia; dysarthria; static tremor; spasticity, gait disturbances; transient bowel incontinence disturbances; transient bowel incontinence

Late Late Dementia; scanning speech; nystagmus; intention tremor; Dementia; scanning speech; nystagmus; intention tremor;

hemiplegia; generalized muscular weakness and atrophy; hemiplegia; generalized muscular weakness and atrophy; inability to stand and walk; loss of bowel and bladder inability to stand and walk; loss of bowel and bladder control control

Potential ComplicationsPotential Complications

Some individuals have frequent attacks, Some individuals have frequent attacks, leading to rapid incapacitation with an leading to rapid incapacitation with an unremitting, progressive course that ends in unremitting, progressive course that ends in death within 1 to 2 years.death within 1 to 2 years.

Others are prone to complications related to Others are prone to complications related to progressive disease and disuse syndrome, progressive disease and disuse syndrome, such as pressure sores, contractures, such as pressure sores, contractures, pathologic fractures, pneumonia, renal pathologic fractures, pneumonia, renal infection, and septicemiainfection, and septicemia

Death usually is caused by complications Death usually is caused by complications rather than the primary disease. rather than the primary disease.

Diagnostic TestsDiagnostic Tests

elevated cerebrospinal fluid (CSF) IgG elevated cerebrospinal fluid (CSF) IgG coupled with normal serum IgGcoupled with normal serum IgG

normal CSF proteinnormal CSF protein slowed nerve conduction in evoked slowed nerve conduction in evoked

potential studiespotential studies computed tomography computed tomography magnetic resonance imaging scans of magnetic resonance imaging scans of

lesionslesions

TreatmentsTreatments

Surgery Surgery Drugs Drugs General General