Multiple Sclerosis

Points to highlight in Multiple sclerosis :

• Multiple Sclerosis (MS) : is an Autoimmune demyelinating disorder with characteristic remission and relapsing-progressive-course.
• it's multifactorial, with significant genetics susceptibility i.e. always look for positive family history, commoner in young females, with North European Anscent, exacerbated by infections, trauma or psychological stress
• it presents with multiple focal neurological disorders, involving peripheral numbness , tingling or parasthesias , it may be associated with limb instability or ataxia
• blurry vision or Diplopia
• Urinary URGENCY or even RETENTION also may be associated with sudden onset erectile dysfunction in males
• a sentence I like to describe MS is to always consider if a young female presented with multiple focal neurological signs with no connections of anatomy or time.
•  MS can have the following course of progression

1. Remission and relapsing course , though you may consider that once a deficit has developed it wouldn't recover i.e it will always be progressive yet in a Relapsing and remitting pattern
2. Secondary progressive: secondary attacks after the first primary attack is progressive but with no spontaneous remission to the acute exacerbation this time.
3. Primary Progressive , which has the worst prognosis and with no single acceptable management to induce remission 

• MRI is the most Sensitive test for diagnosis with characteristic hyper intense T2 signal and decreased T1 signal intensity
• Evoked Response potential to various visual, auditory or somatosensory stimuli would show decrease potential, though it's a nonspecific finding.
• Lumbar puncture and CSF analysis would show pleocytosis and increased oligoclonal bands IgG via electrophoresis , increased protein content above 100mg/dl is a highly suggestive sign of MS.
• Management of MS:

1. Induction of remission: during acute exacerbation management is started with prednisone IV. for three days then a 4 weeks gradually tapered course of oral corticosteroids , you may also need plasmapharesis
2. maintenance therapy: in remission and relapsing form consider interferon-alpha1B and glatiramir, in secondary progressive type : interferon-alpha1B and mitoxantrone though it is important to know that mitoxantrone is absolutely contraindicated in a patient with underlying cardiac condition with diminished ejection fraction, because it's a highly cardiotoxic drug, there's no acceptable treatment for primary progressive type.
3. complications are treated symptomatically, spasticity is managed with baclofen , urinary retention is treated with Bethanechol (exclude obstructive uropathies) and urgency is treated with oxybutynin, erectile dysfunction is treated with sildenafil.