Multiple sclerosis is a chronic neurological disorder that affects the central nervous system. It is characterized by lesions in the brain and spinal cord that cause inflammation and damage to the myelin sheath surrounding nerves. Symptoms vary depending on the location of lesions but can include visual disturbances, limb weakness, and sensory issues. The course of the disease is usually relapsing-remitting, with periods of symptoms followed by remission, though it can also be progressive with steady worsening over time. While its exact causes are unknown, it is thought to involve an environmental trigger in genetically susceptible individuals. Treatment focuses on managing relapses, symptoms, and slowing disease progression using medications.

1. Multiple sclerosis
Prof. Dr Abid Naeem

4. ➢ Most common chronic neurological disorder affecting young people
➢ In most typical form is characterized by lesions separated in time and
space in central nervous system
➢ More common in temperate than tropical climate
➢ More common in males (M:F 1.5:1)
➢ Usual age of presentation is between ages of 20 – 40
➢ Prevalence in UK of 1 in 1000

5. Path physiology
➢ Affects white matter of brain and spinal cord
➢ Inflammatory cells present and myelin damaged
➢ Foci of inflammation and demyelization known as plaques
➢ Initially inflammation and edema, followed by loss of myelin and
then gliosis (scar tissue)
➢ Leads to reduction in conduction velocity
➢ Thought that environmental agent (e.g. virus) triggers condition in
genetically susceptible individual

6. Presentation
➢ Visual disturbance
➢ Optic neuritis caused by inflammatory demyelization of one optic
nerve
➢ Pain around one eye especially on eye movement
➢ Blurred vision which may progress to monocular blindness over days
or weeks
➢ Loss of colour vision
➢ Limb weakness and sensory disturbance
➢ Lesion in spinal cord or cerebral hemispheres
➢ May have tingling sensation down back +/or limbs on neck flexion
➢ Symptoms may be worse after hot bath

7. ➢ Course
1-Relapsing-remitting
➢ After episode may be resolution of symptoms (80% patients)
➢ After further episodes may be some residual disability
2-Secondary progressive
➢ Steady progression without resolution complete or near-completion
3- Primary progressive
➢ 10% patients have this form of disease with no clear relapses and
remissions

8. Multiple sclerosis

10. Differential Diagnosis
➢ SLE and related collagen vascular disease and vasculitis.
➢ Cerebral stroke
➢ Neoplasm (lymphoma, glioma and meningioma).
➢ Behçet’s disease.
➢ HIV.

11. Management
➢ If relapse severe enough to limit function – Treat with steroids
➢ Symptom control
➢ Spasticity, fatigue, bladder disturbance, depression, pain
➢ Disease modifying therapy
➢ Interferon beta and glatiramer acetate

13. Thanks