The document discusses multiple sclerosis (MS), detailing its pathophysiology, clinical features, and variants, including relapsing and progressive forms. It highlights the importance of MRI for diagnosis and outlines treatment options for acute exacerbations and symptomatic management. The key take-home message is that MS is an inflammatory disease of the CNS with a typical relapsing and remitting pattern, where immunomodulators are the preferred treatment.

1. Multiple Sclerosis
Dr Bhupendra Shah
Assistant Professor
B.P. koirala Institute of Health Sciences

3. Beautiful movie………..

4. MULTIPLE SCLEROSIS

5. WHERE IS MULTIPLE SCLEROSIS?

6. PATHOPHYSIOLOGY OF MULTIPLE SCLEROSIS

7. Clinical features:

8. Few interesting symptoms…
• Uhthoff’s phenomenon
• Lhermitte’s symptoms

9. VARIANTS OF MULTIPLE SCELEROSIS
PROGRESSIVE RELAPSING
SECONDARY PROGRESSIVE
PRIMARY PROGRSSIVE
RELAPSING AND REMMITING

10. INVESTIGATION

11. PLAQUE
MRI in Multiple Sclerosis

13. CSF IN MULTIPLE SCELOROSIS

14. MC DONALD CRITERIA FOR MULTIPLE SCLEROSIS
ATTACK CLINICAL
LESION
REQUIREMENT
2 2 None
2 1 Dissemination is space by MRI(in different areas)
1 2 Dissemination in time by MRI(different lesion new and old)
1 1 Dissemination in space and time

15. TREAMENT

16. • Acute exacerbation
usually in relapsing and
remmiting variants
• Shorter course

18. Symptomatic managment
PROBLEM DRUGS
Spasticity Physiotherapy, muscle relaxant
Ataxia Isoniazide, clonazepam
Dystheisia Carbamazepine, amitriptyline

19. TAKE HOME MESSAGE
• inflammatory disease of white matter of CNS .
• Shows relapsing and remmiting pattern
• MRI is choice of investigation
• Immunomodulator is a drug of choice .