6/20/16: Multiple Sclerosis

  • Recognize the risk factors for MS:
    • Age: typically younger (20-40 years old)
    • Female > Male (3:1)
    • Family History of MS
    • Infections (EBV)
    • Race – white, northern European decent
    • Smoking
    • Autoimmune disease
    • Northern hemispheres (potentially related to lack of sunlight / vitamin D deficiency)
  • Remember the THREE TYPES OF MS:
    • Primary progressive (Green)
    • Relapsing/Remitting (Blue)
    • Secondary progressive (Red)


Lhermitte Sign: a shock-like sensation radiating down the spine or limbs induced by neck movements.

Uhthoff Phenomenon: worsening MS symptoms with increased body temperature.

  • Diagnosis requires the evidence of CNS demylenation in BOTH SPACE AND TIME.
  • Remember the common eye findings with MS:
    • Optic neuritis: occurs in 50% of MS patients and is the presenting symptom in 20-30%
    • MLF syndrome: inability to adduct the affected eye; opposite eye can experience nystagmus
    • Marcus Gunn Pupil (afferent pupillary defect): inability of the affected eye to constrict when light is shown
  • Oligoclonal bands IgG on LP
  • Treatment regimen:
    • Routine: physical activity, vitamin D/calcium, routine vaccinations, smoking cessation
    • Acute: high dose steroids (typically 1 g/day for 3-5 days)

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