Multiple Sclerosis.

Summary of Key Points

 

Multiple Sclerosis is a very complex disease.

 

The incidence is between 1: 2,000 and 1: 10,000 depending on geographic location (temperate or tropics, respectively). This disease is one of young adults. Average age of onset is 29-33 years. Twice as common in women than men. One of most common diseases of CNS and is an inflammatory demyelinating condition. It interferes with the smooth, rapid and coordinated muscular (limb) movement. Primary or secondary progressive only likely conditions covered.

 

Primary MS is characterised though by lack of distinct attacks. Slow onset and steadily worsening symptoms. Accumulation of deficits. Occurs in about 15% MS sufferers. Secondary is initially relapsing-remitting MS. Development of progressive disability later. Often superimposed with relapses. About 40% of cases. Both primary and secondary MS may not easily fit a description - lack of distinct attacks but will an "attack" last 6 months or more? Probably - primary is steadily worsening symptoms. Secondary is initially relapsing-remitting so an "attack" is likely to come and go so can be used as a symptom of a pre-existing condition. This excludes the 40% and leaves the 15% possible.

 

Early MS may present as history of vague symptoms. May be transitory and vague and confusing to both doctor and patient. Doctor may not say MS is suspected. The course is unpredictable. There is no typical MS, it is a clinical diagnosis and no specific test (100% conclusive) for it. The type of symptom, onset and pattern may suggest MS. Some symptoms are common to all sufferers but although most will experience more than one symptom no person would have them all. Some are immediately obvious (optic neuritis) but some are less so - fatigue, altered sensation, memory and concentration. Many of the signs - identical abnormalities - could be attributed to a number of medical conditions. These abnormalities in nerve pathways but could not conclude cause of abnormality.

 

Other causes must be eliminated (PD/MND/Alzheimer's Disease). Several tests and procedures are needed to establish a diagnosis of MS. This may include lumbar puncture to test the cerebrospinal fluid for antibodies and MRI to give pictures of scarring evidence of brain and spinal cord (only test to see such lesions) but this is only a significant indicator and not conclusive. These scars appear in different areas of brain and spinal cord at different times.

 

Primary symptoms

 

pain

 

     trigeminal neuralgia (facial pain)

     tightness around joints (low back pain)

     paralysis (similar to stroke) - can be PTD

     loss of vision (optic neuritis) - can be PTD

 

changes in eye movements

 

     involuntary rapid eye movement (nystagmus)

     double vision (diplopia) - blurring of vision

     total loss of sight (rare)

     opsoclonus ("jumping vision") a related eye disorder

 

tremor - uncontrollable shaking. Can occur in various parts of body

 

     intention tremor is shaking when at rest

     postural tremor is limb or whole body supported against gravity co-ordination

     ataxia (unstable walking)

     loss of balance -    

 

weakness

 

     vertigo (giddiness, common symptom)

     clumsiness of limb

 

bladder and bowel dysfunction

 

     urination often and/or urgently

     incomplete emptying at inappropriate times

     constipation

     loss of bowel control sensation

 

numbness

 

     parathesia ("pins and needles")

     burning feeling in an area of body

     sensitivity to heat (commonly exacerbates symptoms)

 

Abnormalities may also include

 

     slurred speech

     loss of speech

     changes in rhythm swallowing (dysphagia)

     mostly advanced stages reflexes

 

fatigue

 

     debilitating and general cognitive function (about 50% will develop some cognitive dysfunction - 50% won't)

     ability to think

 

concentration

 

     judgment

     reason

     remembering

 

strength

 

     particularly affect legs so walking problems

 

spasticity

 

     mobility

     walking spasms

     involuntary muscle stiffness or spasms (wide range)

 

sexuality

 

     impotence

     diminished arousal

     loss of sensation

 

Note that 50% will not develop cognitive dysfunction. Optic neuritis may not affect vision but MS may result. Optic neuritis also does not always develop into MS. About 50-60% do so 40-50% don't. But MS is still the most likely cause. Neurological deficits indicate at least two different areas of CNS and occur at two separate times, at least one month between, and persisting for 24 hours. A neurologist would want to witness at least two distinct episodes. Note that CII requirement is for "attack" to persist for 6 months so it is progressive types of MS only. Ignore both benign and relapse-remitting and so probably secondary progressive as this is how it starts. May develop into secondary but will be compromised by pre-existing condition clause. The "5 year rule" - first 5 years probably indicate how disease will continue but after 5-10 years more reliable indicator.

 

This is the explicit definition that must be primary progressive only - slow deterioration of neurological function without remission - 15% cases. It demonstrates the huge window, maybe as far back as 15 years into the medical history, to find a pre-existing symptom. Will become severely disabled but life expectancy is near normal. Over 55 years of age (in mostly males) at onset more likely to be a faster, more progressive course.

 

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