Ver el código de «Multiple sclerosis»

==Background==
*CNS myelin destruction causes variable motor, sensory, visual and cerebellar dysfunction<ref>Multiple sclerosis: a practical overview for clinicians. British Medical Bulletin, Volume 95, Issue 1, September 2010, Pages 79–104. https://doi.org/10.1093/bmb/ldq017</ref>

===Types===
*'''Relapsing/remitting (most common)'''
**Relapse (days-months) followed by remission
*'''Secondary progressive''' 
**Relapses and partial recoveries occur, but disability does not fade away between cycles
*'''Primary progressive'''
**Symptoms progress slowly and steadily without remission
*'''Progressive relapsing'''
**Similar to primary progressive but with superimposed flares

==Clinical Features==
*Classic patient has multiple presentations for neuro symptoms of different areas of pathology 
**Patient often has resolution of the earlier symptoms
*Symptoms worsen with increases in body temperature, classically after hot showers (Uhthoff's phenomenon<ref>Flensner G, et al. "Sensitivity to heat in MS patients: a factor strongly influencing symptomology-an explorative survey". BMC Neurol. 2011. 11:27.</ref>)
*Muscle/sensory signs:
**Lower extremity [[weakness]] usually worse than upper extremity
**Upper motor neuron signs:
***Hyperreflexia
***Positive Babinski
**[[numbness|Decrease]] in proprioception/pain/temperature sensation
**Lhermitte sign
***Electric shock sensation radiating down back into arms/egs from neck flexion
***If the discomfort is severe, carbamazepine or gabapentin may be beneficial for some patients.
*[[Optic neuritis]]
**Initial sign in 30% of patients
**[[Vision loss]] (usually unilateral) often preceded by retrobulbar pain
**[[Blurred vision]]
**Afferent pupillary defect is suggestive of optic neuritis
**[[Nystagmus]]
**[[Diplopia]]
*[[Internuclear ophthalmoplegia]]
**Abnormal eye adduction bilaterally and horizontal nystagmus
**Convergence (both eyes center medially) is preserved
*Dysautonomia
**[[Urinary retention]] (increased risk of [[UTI]]/[[pyelo]])
**[[Constipation]] or incontinence
**Sexual dysfunction (males)

==Differential Diagnosis==
{{Weakness DDX}}

==Evaluation==
[[File:MS_MRI_1.jpg|thumb|MRI brain with contrast of a patient in her mid-20s with new onset MS. Large lesion in left parietal area.]]
[[File:MS_MRI_2.jpg|thumb|MRI brain with contrast of same patient with new onset MS with another lesion in the left cerebellum.]]
*[[LP|CSF]]
**Elevated protein and gamma-globulin (increased oligoclonal bands)
*[[brain MRI|MRI]]
**Multiple lesions in supratentorial white matter, paraventricular area, spinal cord 
*[[brain MRI|MRI]] with GAD of brain (+/- spine) and orbits (if [[optic neuritis]] suspected)
*CBC, Chemistry
*[[Urinalysis]]

==Management==
*Fever must be reduced to minimize weakness associated with elevated temperature
===Infection Treatment===
*Antibiotics or surgical control of any infectious sources
===Steroids and Immunomodulators===
*High-dose [[Corticosteroids|steroid]] therapy for relapses in the form of oral or intravenous methylprednisolone (1000 mg)<ref>Le Page et al. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet. 2016 Jan 23;387(10016):340. https://core.ac.uk/download/pdf/52993687.pdf</ref>
*Suppression therapies
**IFN B, Glatiramer, Estriol (usually not in ED)

==Disposition==
*Hospitalization indicated for:
**Any disease exacerbation associated with significant morbidity
**IV antibiotics or steroid therapy required
**Depression and significant risk of suicide

==See Also==
*[[Optic Neuritis]]

==References==
<references/>

[[Category:Neurology]]