Multiple sclerosis natural history, complications and prognosis: Difference between revisions
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==Complications== | ==Complications== | ||
Complications that can develop as a result of mutiple sclerosis are: | |||
* medication complication: Insufficient blood supply to the bone can cause avascular osteonecrosis. After trauma corticosteroid treatment is the most common cause of AVN.<ref name="pmid9365096">{{cite journal |vauthors=Yamamoto T, Irisa T, Sugioka Y, Sueishi K |title=Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits |journal=Arthritis Rheum. |volume=40 |issue=11 |pages=2055–64 |date=November 1997 |pmid=9365096 |doi=10.1002/1529-0131(199711)40:11<2055::AID-ART19>3.0.CO;2-E |url=}}</ref><ref name="pmid12430099">{{cite journal |vauthors=Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME |title=Pathogenesis and natural history of osteonecrosis |journal=Semin. Arthritis Rheum. |volume=32 |issue=2 |pages=94–124 |date=October 2002 |pmid=12430099 |doi= |url=}}</ref> | * medication complication: Insufficient blood supply to the bone can cause avascular osteonecrosis. After trauma corticosteroid treatment is the most common cause of AVN.<ref name="pmid9365096">{{cite journal |vauthors=Yamamoto T, Irisa T, Sugioka Y, Sueishi K |title=Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits |journal=Arthritis Rheum. |volume=40 |issue=11 |pages=2055–64 |date=November 1997 |pmid=9365096 |doi=10.1002/1529-0131(199711)40:11<2055::AID-ART19>3.0.CO;2-E |url=}}</ref><ref name="pmid12430099">{{cite journal |vauthors=Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME |title=Pathogenesis and natural history of osteonecrosis |journal=Semin. Arthritis Rheum. |volume=32 |issue=2 |pages=94–124 |date=October 2002 |pmid=12430099 |doi= |url=}}</ref> | ||
* Fatigue: [[Fatigue]] is seen in almost 80% of [[MS]] patient. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that | |||
* mood problems: [[Psychiatric]] disorders especially [[depression]] is common and can be seen in almost 50% of [[MS]] patients. Some studies show higher risk of [[suicide]] in [[MS]] patient. | |||
* Spasticity: Damage to the upper motor neurons and decrease inhibition of lower motor neurons in [[MS]] can increase muscle tone and rigidity in 75% of [[MS]] patients. | |||
* Bowel and bladder dysfunction: [[Bowel]] and [[bladder]] dysfunction is common in [[MS]] patients and accurse in more than 50% of them. [[bladder]] dysfunction can be the result of [[Detrusor hyperactivity|Detrusor overactivity]], Detrusor sphincter dyssynergia, Inefficient [[bladder]] [[contractility]] and Abnormal [[sensation]] and [[bladder]] hypoactivity. the most common [[bowel]] problems include [[Constipation]], poor [[defecation]] and [[incontinence]]. | |||
* Cognitive impairment: [[Cognitive disorder|Cognitive disorders]] is common in [[MS]] patients and can even present at early stages of disease. These disorders are in [[attention]], short term memory and information processing. Relapsing-remitting type of [[MS]] seems to have lower [[Cognitive disorder|cognitive problems]]. | |||
* Heat sensitivity: Patients with [[MS]] disease are more sensitive to heat. A slight increase in [[body temperature]] of these patients will lead to worsening of their [[Sign (medicine)|sign]]<nowiki/>s and [[symptom]]<nowiki/>s. | |||
* Incoordination: involvement of [[cerebellar]] tracts can cause Problems in [[Gait]] and balance, poor coordinated actions and [[slurred speech]]. [[Intention tremor]] is present in most of these patients. | |||
* Pain: [[Pain]], a very common [[symptom]] in [[MS]] patients can be either from [[neurogenic]] source leading to burning or ice-cold [[dysesthesias]] or from long immobilization and [[spasm]]. | |||
* Sexual dysfunction: [[Sexual dysfunction]] can be due to involvement of [[Motor disorders|motor]] and [[Sensory system|sensory]] pathways or from [[psychological]] problems but either way, it’s a very common [[symptom]]. In women we can see reduced [[libido]] and [[orgasm]], [[dyspareunia]] and decrease [[vaginal]] sensation. Presentations of sexual dysfunction in men are decreased [[libido]] and [[premature ejaculation]], [[erectile dysfunction]] and decreased [[Penis|penile]] sensation. | |||
* Sleep disorders: Many patients with multiple sclerosis suffer from [[sleep disorders]] and daytime [[somnolence]]. This can be the result of so many conditions including [[restless leg syndrome]], [[nocturia]], [[pain]] and medication side effects. Having more cervical lesions lead to experiencing [[restless leg syndrome]] more often. | |||
* vertigo: Benign positional paroxysmal [[vertigo]] is the most common cause of [[vertigo]] in [[MS]] patient. In the course of the disease about 30-50% of patients experience this [[symptom]]. | |||
* visual loss: [[Optic neuritis]] is the most common eye involvement and presents as an [[acute]] unilateral eye [[pain]], followed by some degree of [[vision loss]]. | |||
== Prognosis == | == Prognosis == | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Please help WikiDoc by adding more content here. It's easy! Click here to learn about editing.
Overview
Natural History
The symptoms of multiple sclerosis usually develop in the first/ second/ third decade of life, and start with symptoms such as optic neuritis, diplopia, sensory or motor loss, vertigo and balance problems. In young adult eye and sensory problems are prominent while in older patients we see motor problems more often.[1]
Complications
Complications that can develop as a result of mutiple sclerosis are:
- medication complication: Insufficient blood supply to the bone can cause avascular osteonecrosis. After trauma corticosteroid treatment is the most common cause of AVN.[2][3]
- Fatigue: Fatigue is seen in almost 80% of MS patient. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that
- mood problems: Psychiatric disorders especially depression is common and can be seen in almost 50% of MS patients. Some studies show higher risk of suicide in MS patient.
- Spasticity: Damage to the upper motor neurons and decrease inhibition of lower motor neurons in MS can increase muscle tone and rigidity in 75% of MS patients.
- Bowel and bladder dysfunction: Bowel and bladder dysfunction is common in MS patients and accurse in more than 50% of them. bladder dysfunction can be the result of Detrusor overactivity, Detrusor sphincter dyssynergia, Inefficient bladder contractility and Abnormal sensation and bladder hypoactivity. the most common bowel problems include Constipation, poor defecation and incontinence.
- Cognitive impairment: Cognitive disorders is common in MS patients and can even present at early stages of disease. These disorders are in attention, short term memory and information processing. Relapsing-remitting type of MS seems to have lower cognitive problems.
- Heat sensitivity: Patients with MS disease are more sensitive to heat. A slight increase in body temperature of these patients will lead to worsening of their signs and symptoms.
- Incoordination: involvement of cerebellar tracts can cause Problems in Gait and balance, poor coordinated actions and slurred speech. Intention tremor is present in most of these patients.
- Pain: Pain, a very common symptom in MS patients can be either from neurogenic source leading to burning or ice-cold dysesthesias or from long immobilization and spasm.
- Sexual dysfunction: Sexual dysfunction can be due to involvement of motor and sensory pathways or from psychological problems but either way, it’s a very common symptom. In women we can see reduced libido and orgasm, dyspareunia and decrease vaginal sensation. Presentations of sexual dysfunction in men are decreased libido and premature ejaculation, erectile dysfunction and decreased penile sensation.
- Sleep disorders: Many patients with multiple sclerosis suffer from sleep disorders and daytime somnolence. This can be the result of so many conditions including restless leg syndrome, nocturia, pain and medication side effects. Having more cervical lesions lead to experiencing restless leg syndrome more often.
- vertigo: Benign positional paroxysmal vertigo is the most common cause of vertigo in MS patient. In the course of the disease about 30-50% of patients experience this symptom.
- visual loss: Optic neuritis is the most common eye involvement and presents as an acute unilateral eye pain, followed by some degree of vision loss.
Prognosis
there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis but We can’t surly say what is the prognosis of MS patients.[4]
Relapsing versus progressive disease
Progressive form of MS seems to have worse prognosis in comparison to relapsing remitting form of MS. Disabilities start sooner in progressive form[5][6][7] but some studies showed that age of onset is more important in MS disability than the form of the disease.[8][9]
Early symptoms
Some first manifestations of MS disease like bowel and bladder dysfunction, seems to have a worse prognosis.[10]. Another study demonstrated that having so many symptoms at the onset of the disease have a worse prognosis than being monosymptom.[11]
Demographics
Onset of MS in Black Americans is in later age and they are more susceptible of having multifocal signs and symptoms and involvement of optic nerve and spinal cord.[12]
Sex
Women seems to have younger age of onset and so better prognosis than men.[5]
Smoking
Transition of RRMS to SPMS can be accelerated with smoking.[13]
References
- ↑ Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC (February 1989). "The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability". Brain. 112 ( Pt 1): 133–46. PMID 2917275.
- ↑ Yamamoto T, Irisa T, Sugioka Y, Sueishi K (November 1997). "Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits". Arthritis Rheum. 40 (11): 2055–64. doi:10.1002/1529-0131(199711)40:11<2055::AID-ART19>3.0.CO;2-E. PMID 9365096.
- ↑ Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME (October 2002). "Pathogenesis and natural history of osteonecrosis". Semin. Arthritis Rheum. 32 (2): 94–124. PMID 12430099.
- ↑ Swanton J, Fernando K, Miller D (2014). "Early prognosis of multiple sclerosis". Handb Clin Neurol. 122: 371–91. doi:10.1016/B978-0-444-52001-2.00015-7. PMID 24507526.
- ↑ 5.0 5.1 Weinshenker BG (1994). "Natural history of multiple sclerosis". Ann. Neurol. 36 Suppl: S6–11. PMID 8017890.
- ↑ Confavreux C, Vukusic S, Moreau T, Adeleine P (November 2000). "Relapses and progression of disability in multiple sclerosis". N. Engl. J. Med. 343 (20): 1430–8. doi:10.1056/NEJM200011163432001. PMID 11078767.
- ↑ Tremlett H, Paty D, Devonshire V (January 2006). "Disability progression in multiple sclerosis is slower than previously reported". Neurology. 66 (2): 172–7. doi:10.1212/01.wnl.0000194259.90286.fe. PMID 16434648.
- ↑ Confavreux C, Vukusic S (March 2006). "Age at disability milestones in multiple sclerosis". Brain. 129 (Pt 3): 595–605. doi:10.1093/brain/awh714. PMID 16415309.
- ↑ Confavreux C, Vukusic S (March 2006). "Natural history of multiple sclerosis: a unifying concept". Brain. 129 (Pt 3): 606–16. doi:10.1093/brain/awl007. PMID 16415308.
- ↑ Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM (December 2006). "Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review". Arch. Neurol. 63 (12): 1686–91. doi:10.1001/archneur.63.12.1686. PMID 17172607.
- ↑ Kremenchutzky M, Rice GP, Baskerville J, Wingerchuk DM, Ebers GC (March 2006). "The natural history of multiple sclerosis: a geographically based study 9: observations on the progressive phase of the disease". Brain. 129 (Pt 3): 584–94. doi:10.1093/brain/awh721. PMID 16401620.
- ↑ Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL (December 2004). "Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis". Neurology. 63 (11): 2039–45. PMID 15596747.
- ↑ Roudbari SA, Ansar MM, Yousefzad A (July 2013). "Smoking as a risk factor for development of Secondary Progressive Multiple Sclerosis: A study in IRAN, Guilan". J. Neurol. Sci. 330 (1–2): 52–5. doi:10.1016/j.jns.2013.04.003. PMID 23628463.