MULTIPLE SCLEROSIS

1-it is an autoimmune disease of white matter which occurs due to interaction of genetic factors with enviornomental factors
2:-most frequently affects young &middle aged people
3-characterised by chronic inflammation, demyelination axonal loss with remission &exacerebation of signs symptoms
Classification
1- Relapsing remitting multiple sclerosis 85%
it is characterised by signs &symptoms typicaly evolve over period of several days stabilise then improve spontaneously or in response to costicosteroids
2- secondary progressive multiple sclerossis
it is characterised by gradual progression of disability with or without superimposed replase
3- Primary progressive multiple sclerossis 10%
it is characterised by gradual progression of disability without superimposed relapse
4-Progressing relapsing multiple sclerossis 5%
it is characterised by gradual progression of disability from disease onset with or without relapse in the course of disease

C /F
1) Motor features
*predominately upper motor neuron weakness of muscles (brisk deep tendon reflex Babinski's sign, loss of abdominal reflex )
*wasting of muscles of hands
2)Sensory features
*tingling numbness
*objective sensory loss including posterior column features
3)Other features
*optic neuritis
*3rd cranial nerve palsy & worsening of symptoms on exposure to heat i.e Uthoff's phenomenon
4)Paroxymal features
*trigeminal neuralgia, facial weakness vertigo dysarthria
*Lhermitte sign- shooting electric pain in neck with radiation to shoulder on flexing neck due to posterior column involvement
Diagnosis
1- age of onset between 10 to 25yr
2- an acute episode must last for atleast 24 hrs in absence of fever
3- precence of prominent cortical sign exclude MS
MANAGEMENT
A) Investigations
1- csf- increased cells raised protein increased IgG
2- visual , auditary show prolongation
3-MRI is very sensitive
B) Treatment
1- Acute exacerebation - methyl prednisolone 1g iv daily for 3days.it is followed by oral prednisolone 60mg for 5days
2- disease modifying drugs- interferon beta.-1b,1a,mitoxantrone.
3- symptomatic treatment
spacticity - bacloèn(15to18mg /day , diazepam5-10mg/day
pain- phenytoin 300to 400mg/day
paroxymal symptoms- carbamazepine gabapentin or acetazolamide