MULTIPLE SCLEROSIS. Multiple sclerosis is an immune mediated inflammatory disease that attacks myelinated axons in the CNS , destroying the myelin and axon in variable degrees and producing significant physical disability within 20- 25 years in more than 30 % of patients. THE HALLMARK OF MS IS SYMPTOMATIC EPISODES THAT OCCUR MONTHS OR YEARS APART AND AFFECT DIFFERENT ANATOMICAL LOCATIONS. CLASSIC SIGNS AND SYMPTOMS OF MS. 1 ) Sensory loss //paraesthesia - early complaint. 2 ) Spinal cord symptoms (motor ) Muscle cramping secondary to spasticity. 3 ) Spinal cord symptoms ( autonomic ) Bladder,bowel and sexual dysfunction. 4 ) Cerebellar symptoms : Charcot triad of dysarthria,ataxia and tremor. 5 ) Optic Neuritis. 6 ) Trigeminal neuralgia : Bilateral facial weakness. 7 ) Facial myokymia : irregular twitching of facial muscles. 8 ) Eye symptoms :diplopia on lateral gaze. 9 ) Heat intolerance. 10 ) Constitutional symptoms : fatigue. 11 ) Subjective cognitive difficulties : with regard to attention span,concentration,memory and judgement. 12 ) Euphoria or depression. 13 ) Bipolar disorder or Frank dementia. 14 ) Symptoms associated with partial Acute transverse myelitis. DIAGNOSIS. MS is diagnosed on the basis of clinical findings and tests. MRI : Helps to confirm the disease and monitor disease progression in CNS Lumbar puncture.CSF is evaluated for oligoclonal bands and intrathecal immunoglobulin G Ig G production. CLASSIFICATION. Divided based on clinical criteria. 1 ) Relapsing-remitting MS ( RRMS ) 2 ) Secondary progressive MS ( SPMS ). 3 ) Primary progressive MS ( PPMS ). 4 ) Progressive- relapsing MS.( PRMS ) MANAGEMENT. TREATMENT OF MS HAS TWO ASPECTS. 1.IMMUNOMODULATORY THERAPY FOR UNDERLYING IMMUNE DISORDER. 2.SYMPTOMATIC TREATMENT. Treatment of Acute relapses. Methyl prednisolone. Plasmapheresis. Dexamethasone. Disease modifying agents for MS ( DMAMS ) approved for use are Interferon beta - 1a. Interferon beta - 1b. Peginterferon beta -1a. Mitoxantrone. Alemtuzumab. Daclizumab. Natalizumab. Treatment of aggressive MS High dose cyclophosphamide. Mitoxantrone. Treatment of Fatigue -amantadine,fluoxetine. Depression - selective serotonin trip take inhibitors Spasticity - Baclofen is preferred. Pain - tricyclic anti depressants. Sexual dysfunction - sildenafil,tadalafil,vardenafil.Optic Neuritis.- intravenous methyl prednisolone. PHYSICAL EXAMINATION. A thorough physical examination including neurological assessment is critical to determine deficits in MS.All systems mustbeaddressed, Including cognition,mood,motor,sensory and musculoskeletal systems. Check for Reflexes. Coordination. Bulbar function. Vision. GAIT. Skin. MS IN A NUTSHELL. MS IS AN AUTOIMMUNE DISEASE. MYELIN OF NERVE CELLS IN BRAIN AND SPINAL CORD ARE DAMAGED. THIS ATTACK LEAVES BEHIND SCARS , CALLED SCLEROSIS. WHEN THE MYELIN IS DAMAGED,SIGNALS FROM BRAIN ARE INTERRUPTED,CAUSING THE SYMPTOMS OF MULTIPLE SCLEROSIS. SYMPTOMS -DEMYELINATION. D : DIPLOPIA DOUBLE VISION. DYSMETRIA LACK OF COORDINATION WITH DISTANCE. DYSDIADOCHOKINESIS - INABILITY TO PERFORM RAPID ALTERNATE MOVEMENTS. E : EYE MOVEMENTS PAINFUL - OPTIC NEURITIS M : MOTOR WEAKNESS,SPASTICITY. Y : NYSTAGMUS INVOLUNTARY EYE MOVEMENTS E : ELEVATED TEMPERATURE UHTHOFF'S PHENOMENON. L : LHERMITTE'S PHENOMENON - ELECTRIC SHOCK SENSATION DOWN BACK AND THIGHS ON BENDING NECK. I : ------------- N : NEUROPATHIC PAIN TRIGEMINAL NEURALGIA A : ATAXIA. T : TALKING SLURRED.DYSARTHRIA. I : IMPOTENCE. O : OVERACTIVE BLADDER. N : NUMBNESS,