Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems

1. Amr Hassan, M.D.
Associate professor of Neurology - Cairo
University
Multiple Sclerosis

2. Definition
Multiple sclerosis (M.S.) is an immune-mediated
inflammatory disease that attacks myelinated axons in
the central nervous system (CNS).

3. White matter

4. Myeline

10. Pathophysiology

11. Pathophysiology

15.  The cause of MS is unknown, but it is likely that
combination of multiple factors act in concert to
trigger the disease.
 In other words, it is an autoimmune disease trigged
by an environmental factor in genetically
susceptible patient.

16. Genetics
EnvironmentAutoimmunity

18. 18

19. 19

20. 20

21. 21

22. Clinical picture
Age: 3rd and 4th decades.
Clinical picture: Any myelinated area of the C.N.S. can
be affected resulting in:
Speech disturbances: (Dysarthria):
- Slurred. - Staccato.
- Scanning.

23. Clinical picture
2. Cranial nerve involvement:
II. The optic nerve:
The optic neuritis:
Acute painful diminution or loss of vision.
Visual field defects (specially central scotoma) and
disturbances of colour vision due to selective
involvement of the macular fibres.
Pallor of the optic disc specially on the temporal side.
Secondary optic atrophy.

24. Clinical picture
III, IV,VI The oculomotor nerves
 Diplopia = double vision.
 Ophthalmoplegia = weakness or paralysis of the
extraocular muscles.
 Ophthalmoplegia-internuclearis due to lesion of
the medial longitudinal bundle (MLB) which carries
the fibers of the conjugate eye movements.

25. Clinical picture
VII.The facial nerve:
 U.M.N.L. (common) or L.M.N.L. (rare) facial palsy.
 Hemifacial spasm.
VIII.The cochleo-vestibular nerve:
 Vertigo (common).
 Hearing impairment (rare).
IX,X . Pseudo-bulbar palsy.

26. Clinical picture
4. Motor system affection:
 This may take the form of monoparesis, paraparesis
,hemiparesis or quadriparesis of U.M.N.L. nature i.e.
hypertonia, hyperreflexia, +ve Babinski sign and early loss
of the abdominal reflexes.
5. Sensory system affection:
 Transient numbness and paraesthesias.
 Superficial and/or deep sensory loss.
 +ve L'hermite's sign may be present: on flexion of the head
there is sudden electric like sensation radiating to the back
and limbs, it is due to posterior column involvement in the
cervical region.

27. Clinical picture
6. Cerebellar affection:
 Cerebellar ataxia is a common presentation; it is
associated with nystagmus, staccato speech, intention
kinetic tremors and gait disturbances.
7. Autonomic disturbances:
 Sphincteric troubles: precipitancy, hesitancy of
autonomic bladder.
 Impotence.

28. The Expanded Disability Status
Scale (EDSS)
The Expanded Disability Status Scale (EDSS)
is a method of quantifying disability in multiple sclerosis and
monitoring changes in the level of disability over time. It is widely used
in clinical trials and in the assessment of people with MS.
 The EDSS scale ranges from 0 to 10 in 0.5 unit increments that
represent higher levels of disability. Scoring is based on an examination
by a neurologist. EDSS steps 1.0 to 4.5 refer to people with MS who are
able to walk without any aid and is based on measures of impairment
in eight functional systems.

31. Clinical courses

32. Investigations
 MRI brain: multiple white matter CNS demyelinating
lesions (plaques).
 Neurophysiological studies  evoked potential
studies: visual evoked potential( VEP), brainstem
auditory evoked potential (BAEP), somatosensory
evoked potential: (SSEP) showed delayed latency of
the resposes due to demyelination.
 CSF analysis: +ve IgG index, oligoclonal bands.

37. Treatment
Medical treatment:
 Treatment of an attack: Pulse steroid therapy.
 Treatment in between attacks: Interferone and
immunosuppressant drugs.
 Symptomatic treatment: e.g. muscle relaxants.
Physiotherapy.

38. Thank you