Multiple sclerosis overview: Difference between revisions
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{{Template:Multiple sclerosis}} | {{Template:Multiple sclerosis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Fs}} | ||
== Overview == | == Overview == | ||
Multiple sclerosis is a [[disease]] of the [[central nervous system]] and it’s known to be multi factorial. The most common [[risk factors]] in the development of multiple sclerosis are [[smoking]], [[genetic]], [[Ethnic group|ethnic]], [[infection]], low [[vitamin D]], and [[Stress (medicine)|stress]]. Whatever the [[trigger]] is, it will lead to an acquired [[immune response]] followed by [[Inflammation|inflammatory]] reactions. These reactions lead to secretion of [[cytokines]] in the [[CNS]] [[parenchyma]] and activation of resident [[microglia]]. [[Microglia]] cells activate [[astrocytes]] to release more [[Inflammation|inflammatory]] [[cytokines]], leading to recruitment and [[Infiltration (medical)|infiltration]] of circulatory [[leukocytes]]. This burst events cause destruction of [[myelin sheath]] and forms focal sclerotic [[white matter]] plaques, which are characteristic of multiple sclerotic disease. The onset of [[symptoms]] is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty and include [[fatigue]], [[mood]] problems, [[spasticity]], [[bowel]] and [[bladder]] [[dysfunction]], [[cognitive impairment]], [[Ophthalmoplegia|eye movement problems]], heat sensitivity, [[incoordination]], [[pain]], [[sexual dysfunction]], [[Sleep disorders|sleep disorder]], [[vertigo]] and [[visual loss]]. There is no single diagnostic study of choice for the [[Diagnosis-related group|diagnosis]] of multiple sclerosis, but multiple sclerosis can be diagnosed based on [[History and Physical examination|clinical presentation]], [[cerebral]] plaques on [[MRI]] , and [[oligoclonal bands]] in [[CSF analysis]]. The predominant [[therapy]] for multiple sclerosis is disease-modifying treatment in relapsing-remitting multiple sclerosis, [[Immunosuppression|immunosuppressive threpay]] in progressive multiple sclerosis and [[Glucocorticoid]] [[therapy]] in [[acute]] exacerbation. | |||
==Historical Perspective== | ==Historical Perspective== | ||
Multiple sclerosis was first described by a [[neurologist]], Dr. Jean Martin Charcot in 1868 and named sclerose en plaque. The [[signs]] and [[symptoms]] including [[dysarthria]], [[ataxia]] and [[tremor]] were called charcot’s triad. | Multiple sclerosis was first described by a [[neurologist]], Dr. Jean Martin Charcot in 1868 and named sclerose en plaque. The [[signs]] and [[symptoms]] including [[dysarthria]], [[ataxia]] and [[tremor]] were called [[Charcot's triad|charcot’s triad]]. | ||
==Classification== | ==Classification== | ||
Multiple sclerosis may be classified into four groups according to [[clinical]] course of the [[disease]] including relapsing-remitting, secondary-progressive, | Multiple sclerosis may be classified into four groups according to [[clinical]] course of the [[disease]] including relapsing-remitting, secondary-progressive, | ||
primary-progressive and progressive-relapsing | primary-progressive and progressive-relapsing. other variants of Multiple sclerosis include clinically isolated syndrome and radiologically isolated syndrome. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Multiple sclerosis is a [[disease]] of [[central nervous system]] and it’s known to be multi factorial. Whatever the trigger is, it will lead to acquired [[immune response]] followed by [[ | Multiple sclerosis is a [[disease]] of the [[central nervous system]] and it’s known to be multi factorial. Whatever the trigger is, it will lead to an acquired [[immune response]] followed by [[inflammatory]] reactions. These reactions lead to secretion of [[cytokines]] in the [[CNS]] [[parenchyma]] and activation of resident [[microglia]]. [[Microglia]] cells activate [[astrocytes]] to release more [[Inflammation|inflammatory]] [[cytokines]], leading to recruitment and [[Infiltration (medical)|infiltration]] of circulatory [[leukocytes]]. This burst events cause destruction of [[myelin sheath]] and forms focal sclerotic [[white matter]] plaques, which are characteristic of multiple sclerotic disease. There is some evidence proving [[genetic]] involvement in onset of [[MS]] so that it increases the risk of developing [[MS]] from 0.1% in general population to 3% in those who have siblings with [[MS]] and 25% in those with a mono-zygote [[twin]] affected. Based on studies performed on [[post mortem]] [[brain tissue]] of patients with multiple sclerosis, there are four types of [[white matter]] lesion pathology. Damage to [[myelin sheath]] is prominent in type 1 and 2 while type 3 and 4 characteristic is dying [[Oligodendrocyte|oligodendrocytes]]. the [[etiology]] of [[Oligodendrocyte|oligodendrocytes]] death known to be multi-factorial or followed by [[hypoxia]], [[mitochondrial]] dysfunction and [[Macrophage|macrophages]]. | ||
==Causes== | ==Causes== | ||
Multiple sclerosis may be caused by different categories of causes include: [[Autoimmunity]], [[genetic]], [[infectious]] and [[Degeneration (medical)|degeneration]]. | Multiple sclerosis may be caused by different categories of causes include: [[Autoimmunity]], [[genetic]], [[infectious]] and [[Degeneration (medical)|degeneration]]. | ||
==Differentiating Multiple Sclerosis from other Diseases== | ==Differentiating Multiple Sclerosis from other Diseases== | ||
Multiple sclerosis must be differentiated from other diseases that can mimic this disease [[Clinical|clinically]] or [[Radiological|radiologically]] such as [[ | Multiple sclerosis must be differentiated from other diseases that can mimic this disease [[Clinical|clinically]] or [[Radiological|radiologically]] such as [[systemic lupus erythematosis]], [[Sjögren’s syndrome]], [[vasculitis]], neuro-[[Behçet's disease|behçet’s disease]], [[sarcoidosis]], [[Antiphospholipid syndrome|antiphospholipid (Hughes) syndrome]] , [[Susac's syndrome|susac syndrome]], [[lyme disease]], [[syphilis]], [[HTLV-1|HTLV-1 infection]], [[HIV]]-Related Disorders of the [[CNS]], [[migraine]], [[cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy]], [[Leber's hereditary optic neuropathy|leber’s hereditary optic neuropathy]], [[vitamin B12 deficiency]], [[metachromatic leukodystrophy]], [[Fabry's disease|Fabry’s disease]], [[Krabbe disease|Krabbe’s disease]], [[adrenoleukodystrophy]], [[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes|mitochondrial encephalopathy epilepsy lactic acidosis and stroke like episode]], [[stroke]], [[primary CNS lymphoma]] , and [[dural arteriovenous fistula]] and true malformations. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The majority of multiple sclerosis cases are reported in northern Europe, continental North America, and Australasia, which is about one of every 1000 citizens. Factors including sunlight exposure, climate, [[diet]], [[toxins]], [[genetic]] factors, geomagnetism, Childhood environmental factors and [[infections]] have been proved to cause these differences in [[MS]] prevalence. [[MS]] is at least two times more common among women than men. | The majority of multiple sclerosis cases are reported in northern Europe, continental North America, and Australasia, which is about one of every 1000 citizens. Factors including sunlight exposure, climate, [[diet]], [[toxins]], [[genetic]] factors, geomagnetism, Childhood environmental factors and [[infections]] have been proved to cause these differences in [[MS]] [[prevalence]]. [[MS]] is at least two times more common among [[women]] than [[men]]. The onset of [[symptoms]] is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty. | ||
==Risk Factors== | ==Risk Factors== | ||
Common [[risk factors]] in the development of multiple sclerosis are smoking, [[genetic]], [[Ethnic group|ethnic]], [[infection]], low | Common [[risk factors]] in the development of multiple sclerosis are [[smoking]], [[genetic]], [[Ethnic group|ethnic]], [[infection]], low [[vitamin D]], and [[stress]]. Less common [[risk factors]] in the development of multiple sclerosis include African Americans, Mexicans, Japanese, Chinese and Filipinos race and [[Epstein Barr virus|Epstein-Barr virus]]. | ||
== Natural History, Complications and Prognosis== | == Natural History, Complications and Prognosis== | ||
Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as [[optic neuritis]], [[diplopia]], [[sensory]] or motor loss, [[vertigo]] and [[Balance disorder|balance]] problems. It may be classified into four groups according to [[clinical]] course of the [[disease]] including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. | Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with [[symptoms]] such as [[optic neuritis]], [[diplopia]], [[Sensory loss|sensory]] or [[Muscle weakness|motor loss]], [[vertigo]] and [[Balance disorder|balance]] problems. It may be classified into four groups according to [[clinical]] course of the [[disease]] including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. [[Complications]] that can develop as a result of multiple sclerosis are: [[medication]] [[complication]], [[Fatigue]], [[mood]] problems, [[Spasticity]], [[Bowel]] and [[bladder]] dysfunction, [[Cognitive impairment]], Heat sensitivity., [[Incoordination]], [[Pain]], [[Sexual dysfunction]], [[Sleep disorder|Sleep disorders]], [[vertigo]], [[visual loss]]. there are some factors associated with a particularly poor [[prognosis]] among [[patients]] with multiple sclerosis such as: Relapsing versus progressive disease, early symptoms, Demographics, Sex, [[Smoking]]. | ||
== Diagnosis == | == Diagnosis == | ||
=== Diagnostic Study of choice === | |||
There is no single diagnostic study of choice for the [[diagnosis]] of multiple sclerosis, but multiple sclerosis can be diagnosed based on [[History and Physical examination|clinical presentation]], [[MRI]] findings, and [[CSF analysis]]. Sequence of diagnostic studies are [[History and Physical examination|history and physical examination]], [[imaging]], and [[CSF analysis]]. The findings are [[cerebral]] plaques which are [[demyelinating]] areas on [[MRI]] and an elevated concentration of [[CSF]] [[oligoclonal bands]]. The diagnostic criteria for multiple sclerosis is [[McDonald criteria]]. | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
The most common [[symptoms]] of multiple sclerosis include: [[Fatigue]], [[mood]] | The most common [[symptoms]] of multiple sclerosis include: [[Fatigue]], [[Mood disorder|mood problems]], [[spasticity]], [[bowel]] and [[bladder]] dysfunction, [[cognitive impairment]], [[Ophthalmoplegia|eye movement problems]], heat sensitivity, [[incoordination]], [[pain]], [[sexual dysfunction]], [[Sleep disorders|sleep disorder]], [[vertigo]] and [[visual loss]]. | ||
=== Physical Examination === | === Physical Examination === | ||
[[Physical examination]] of patients with multiple sclerosis is usually remarkable for [[lhermitte's sign]], [[spasticity]] | [[Physical examination]] of patients with multiple sclerosis is usually remarkable for [[lhermitte's sign]], [[spasticity]], increased [[reflexes]], [[internuclear ophthalmoplegia]], [[optic neuritis]], [[gait disturbance]], and [[urinary incontinence]]. | ||
=== Laboratory Findings === | === Laboratory Findings === | ||
An elevated concentration of [[CSF]] [[oligoclonal bands]] is [[diagnostic]] of multiple sclerosis. | An elevated concentration of [[CSF]] [[oligoclonal bands]] is [[diagnostic]] of multiple sclerosis. | ||
=== | === Electrocardiogram === | ||
On [[MRI]], multiple sclerosis is characterized by [[cerebral]] plaques which are [[demyelinating]] areas. These [[Lesion|lesions]] are commonly | An [[ECG]] may be helpful in the [[diagnosis]] of multiple sclerosis. Findings on an [[ECG]] suggestive of multiple sclerosis include [[atrial fibrillation]], [[ventricular arrhythmia]], shortened or [[Long PR interval|longed P-R interval]], tall waves or peaked waves, [[U waves]], and [[Q waves]]. | ||
=== X-ray === | |||
There are no [[x-ray]] findings associated with multiple sclerosis. | |||
=== Echocardiography and Ultrasound === | |||
There are no [[echocardiography]]/[[ultrasound]] findings associated with multiple sclerosis. | |||
=== CT scan === | |||
Findings on [[CT scan]] suggestive of multiple sclerosis include [[brain atrophy]] and some contrast enhancing plaques. Findings on an Double delayed high dose CT scan suggestive of Multiple sclerosis include enhanced [[lesions]] in double delayed high dose [[CT scan]] which are indicators of [[blood brain barrier]] disruption. | |||
=== MRI === | |||
On [[MRI]], multiple sclerosis is characterized by [[cerebral]] plaques disseminating in space and time which are characteristic of [[demyelinating]] areas. These [[Lesion|lesions]] are commonly void, and located in periventricular [[white matter]], [[cerebellum]], and the [[brain stem]]. These lesions are hyperintense on T2 sections of a [[MRI]]. | |||
=== Other Imaging Findings === | |||
There is no other [[imaging]] findings associated with multiple sclerosis. | |||
=== Other Diagnostic Studies === | === Other Diagnostic Studies === | ||
[[Visual evoked potential| | [[Visual evoked potential|Visual evoked potential studies]], anti[[myelin]] [[antibodies]], and optimal coherence tomography may be helpful in the [[diagnosis]] of multiple sclerosis. | ||
==Treatment== | ==Treatment== | ||
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=== Alternative Therapies === | === Alternative Therapies === | ||
Alternative treatments for multiple sclerosis are: [[Diet (nutrition)|Dietary]] regimens [[herbal medicine]] ( [[marijuana]] ) [[hyperbaric oxygenation]] [[Martial arts therapy|therapeutic practice of martial arts.]] | Alternative [[treatments]] for multiple sclerosis are: [[Diet (nutrition)|Dietary]] regimens [[herbal medicine]] ( [[marijuana]] ) [[hyperbaric oxygenation]] [[Martial arts therapy|therapeutic practice of martial arts.]] | ||
=== Prevention === | === Primary Prevention === | ||
Effective measures for the [[primary prevention]] of multiple sclerosis include: [[Vitamin D]] supplement, [[smoking]] cessation, early exposure to [[infection]]<nowiki/>s. | |||
Secondary | === Secondary Prevention === | ||
There is no established method for [[secondary prevention]] of multiple sclerosis. | |||
=== Tertiary Prevention === | |||
Tertiary: There is strong evidence that [[exercise]] therapy can improve [[muscle]] function and [[mobility]] in multiple sclerosis patients. | Tertiary: There is strong evidence that [[exercise]] therapy can improve [[muscle]] function and [[mobility]] in multiple sclerosis patients. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
Latest revision as of 22:48, 29 July 2020
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Multiple sclerosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Multiple sclerosis overview On the Web |
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American Roentgen Ray Society Images of Multiple sclerosis overview |
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Risk calculators and risk factors for Multiple sclerosis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Multiple sclerosis is a disease of the central nervous system and it’s known to be multi factorial. The most common risk factors in the development of multiple sclerosis are smoking, genetic, ethnic, infection, low vitamin D, and stress. Whatever the trigger is, it will lead to an acquired immune response followed by inflammatory reactions. These reactions lead to secretion of cytokines in the CNS parenchyma and activation of resident microglia. Microglia cells activate astrocytes to release more inflammatory cytokines, leading to recruitment and infiltration of circulatory leukocytes. This burst events cause destruction of myelin sheath and forms focal sclerotic white matter plaques, which are characteristic of multiple sclerotic disease. The onset of symptoms is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty and include fatigue, mood problems, spasticity, bowel and bladder dysfunction, cognitive impairment, eye movement problems, heat sensitivity, incoordination, pain, sexual dysfunction, sleep disorder, vertigo and visual loss. There is no single diagnostic study of choice for the diagnosis of multiple sclerosis, but multiple sclerosis can be diagnosed based on clinical presentation, cerebral plaques on MRI , and oligoclonal bands in CSF analysis. The predominant therapy for multiple sclerosis is disease-modifying treatment in relapsing-remitting multiple sclerosis, immunosuppressive threpay in progressive multiple sclerosis and Glucocorticoid therapy in acute exacerbation.
Historical Perspective
Multiple sclerosis was first described by a neurologist, Dr. Jean Martin Charcot in 1868 and named sclerose en plaque. The signs and symptoms including dysarthria, ataxia and tremor were called charcot’s triad.
Classification
Multiple sclerosis may be classified into four groups according to clinical course of the disease including relapsing-remitting, secondary-progressive, primary-progressive and progressive-relapsing. other variants of Multiple sclerosis include clinically isolated syndrome and radiologically isolated syndrome.
Pathophysiology
Multiple sclerosis is a disease of the central nervous system and it’s known to be multi factorial. Whatever the trigger is, it will lead to an acquired immune response followed by inflammatory reactions. These reactions lead to secretion of cytokines in the CNS parenchyma and activation of resident microglia. Microglia cells activate astrocytes to release more inflammatory cytokines, leading to recruitment and infiltration of circulatory leukocytes. This burst events cause destruction of myelin sheath and forms focal sclerotic white matter plaques, which are characteristic of multiple sclerotic disease. There is some evidence proving genetic involvement in onset of MS so that it increases the risk of developing MS from 0.1% in general population to 3% in those who have siblings with MS and 25% in those with a mono-zygote twin affected. Based on studies performed on post mortem brain tissue of patients with multiple sclerosis, there are four types of white matter lesion pathology. Damage to myelin sheath is prominent in type 1 and 2 while type 3 and 4 characteristic is dying oligodendrocytes. the etiology of oligodendrocytes death known to be multi-factorial or followed by hypoxia, mitochondrial dysfunction and macrophages.
Causes
Multiple sclerosis may be caused by different categories of causes include: Autoimmunity, genetic, infectious and degeneration.
Differentiating Multiple Sclerosis from other Diseases
Multiple sclerosis must be differentiated from other diseases that can mimic this disease clinically or radiologically such as systemic lupus erythematosis, Sjögren’s syndrome, vasculitis, neuro-behçet’s disease, sarcoidosis, antiphospholipid (Hughes) syndrome , susac syndrome, lyme disease, syphilis, HTLV-1 infection, HIV-Related Disorders of the CNS, migraine, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, leber’s hereditary optic neuropathy, vitamin B12 deficiency, metachromatic leukodystrophy, Fabry’s disease, Krabbe’s disease, adrenoleukodystrophy, mitochondrial encephalopathy epilepsy lactic acidosis and stroke like episode, stroke, primary CNS lymphoma , and dural arteriovenous fistula and true malformations.
Epidemiology and Demographics
The majority of multiple sclerosis cases are reported in northern Europe, continental North America, and Australasia, which is about one of every 1000 citizens. Factors including sunlight exposure, climate, diet, toxins, genetic factors, geomagnetism, Childhood environmental factors and infections have been proved to cause these differences in MS prevalence. MS is at least two times more common among women than men. The onset of symptoms is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty.
Risk Factors
Common risk factors in the development of multiple sclerosis are smoking, genetic, ethnic, infection, low vitamin D, and stress. Less common risk factors in the development of multiple sclerosis include African Americans, Mexicans, Japanese, Chinese and Filipinos race and Epstein-Barr virus.
Natural History, Complications and Prognosis
Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as optic neuritis, diplopia, sensory or motor loss, vertigo and balance problems. It may be classified into four groups according to clinical course of the disease including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Complications that can develop as a result of multiple sclerosis are: medication complication, Fatigue, mood problems, Spasticity, Bowel and bladder dysfunction, Cognitive impairment, Heat sensitivity., Incoordination, Pain, Sexual dysfunction, Sleep disorders, vertigo, visual loss. there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis such as: Relapsing versus progressive disease, early symptoms, Demographics, Sex, Smoking.
Diagnosis
Diagnostic Study of choice
There is no single diagnostic study of choice for the diagnosis of multiple sclerosis, but multiple sclerosis can be diagnosed based on clinical presentation, MRI findings, and CSF analysis. Sequence of diagnostic studies are history and physical examination, imaging, and CSF analysis. The findings are cerebral plaques which are demyelinating areas on MRI and an elevated concentration of CSF oligoclonal bands. The diagnostic criteria for multiple sclerosis is McDonald criteria.
History and Symptoms
The most common symptoms of multiple sclerosis include: Fatigue, mood problems, spasticity, bowel and bladder dysfunction, cognitive impairment, eye movement problems, heat sensitivity, incoordination, pain, sexual dysfunction, sleep disorder, vertigo and visual loss.
Physical Examination
Physical examination of patients with multiple sclerosis is usually remarkable for lhermitte's sign, spasticity, increased reflexes, internuclear ophthalmoplegia, optic neuritis, gait disturbance, and urinary incontinence.
Laboratory Findings
An elevated concentration of CSF oligoclonal bands is diagnostic of multiple sclerosis.
Electrocardiogram
An ECG may be helpful in the diagnosis of multiple sclerosis. Findings on an ECG suggestive of multiple sclerosis include atrial fibrillation, ventricular arrhythmia, shortened or longed P-R interval, tall waves or peaked waves, U waves, and Q waves.
X-ray
There are no x-ray findings associated with multiple sclerosis.
Echocardiography and Ultrasound
There are no echocardiography/ultrasound findings associated with multiple sclerosis.
CT scan
Findings on CT scan suggestive of multiple sclerosis include brain atrophy and some contrast enhancing plaques. Findings on an Double delayed high dose CT scan suggestive of Multiple sclerosis include enhanced lesions in double delayed high dose CT scan which are indicators of blood brain barrier disruption.
MRI
On MRI, multiple sclerosis is characterized by cerebral plaques disseminating in space and time which are characteristic of demyelinating areas. These lesions are commonly void, and located in periventricular white matter, cerebellum, and the brain stem. These lesions are hyperintense on T2 sections of a MRI.
Other Imaging Findings
There is no other imaging findings associated with multiple sclerosis.
Other Diagnostic Studies
Visual evoked potential studies, antimyelin antibodies, and optimal coherence tomography may be helpful in the diagnosis of multiple sclerosis.
Treatment
Medical Therapy
The predominant therapy for multiple sclerosis is disease-modifying treatment in relapsing-remitting multiple sclerosis, immunosuppressive threpay in progressive multiple sclerosis and Glucocorticoid therapy in acute exacerbation.
Surgery
Surgery can be helpful in controlling trigeminal neuralgia, tremor, and ataxia.
Alternative Therapies
Alternative treatments for multiple sclerosis are: Dietary regimens herbal medicine ( marijuana ) hyperbaric oxygenation therapeutic practice of martial arts.
Primary Prevention
Effective measures for the primary prevention of multiple sclerosis include: Vitamin D supplement, smoking cessation, early exposure to infections.
Secondary Prevention
There is no established method for secondary prevention of multiple sclerosis.
Tertiary Prevention
Tertiary: There is strong evidence that exercise therapy can improve muscle function and mobility in multiple sclerosis patients.