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General Medicine

Multiple Sclerosis

Jack R. Stacey, MD and Andrew J. McDermott, MD, FAAFP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • An autoimmune disease directed against components of the myelin sheath causing demyelination often leading to progressive axonal loss and eventual CNS atrophy affecting primarily whi...

DIAGNOSIS

A person with MS can present with a number of neurologic signs and symptoms depending on the locations of the lesion. The essential means of diagnoses is to demonstrate evidence of CNS lesio...

TREATMENT

GENERAL MEASURES

  • Holistic multidisciplinary team approach is paramount.

  • Three main categories currently exist for MS treatment: treatment for acute relapses, treatment for reducing MS-related ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Assessing the severity of neurologic impairment from MS can be done using the Kurtzke Expanded Disability Status Scale (EDSS): The EDSS quantifi...

REFERENCES

1
Raffel J, Wakerley B, Nicholas R. Multiple sclerosis. Medicine.  2016;44(9):537–541. [View Abstract on OvidMedline]
2
Amato MP, Bertolotto A, Brunelli R, et al. Management of pregnancy-...

ADDITIONAL READING

Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol.  2015;15(9):545–558. [View Abstract on OvidMedline] 

CODES

ICD10

G35 Multiple sclerosis 

ICD9

340 Multiple sclerosis 

SNOMED

  • 24700007 Multiple sclerosis (disorder)

  • 428700003 Primary progressive multiple sclerosis

  • 425500002 secondary progressive multiple sclero...

CLINICAL PEARLS

  • MS is an immune-mediated inflammatory disease causing demyelination, neuronal loss, and scarring within the CNS.

  • Diagnosis is made with the McDonald criteria and must demonstrate damage...

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Figure 12.49. Multiple sclerosis. A and B. Contiguous T2-weighted MR images show areas of ventricular plaques of high signal (arrows). C. (This is the same patient as in Fig. 12.39B.) T2-weighted image in another patient shows small periventricular plaques (solid arrows) as well as an area of left parietal infarction (open arrow). D. T1-weighted image in another patient shows plaques in the white matter (arrows).
Figure 12.49. Multiple sclerosis. A and B. Contiguous T2-weighted MR images show areas of ventricular plaques of high signal (arrows). C. (...
FIGURE 28-68. Multiple sclerosis. A coronal section of the brain shows periventricular plaques (darker areas) in the white matter (arrows).
FIGURE 28-68. Multiple sclerosis. A coronal section of the brain shows periventricular plaques (darker areas) in the white matter (arrows).
Fig SP 22-2. Multiple sclerosis. (A) Sagittal T2-weighted image shows focal increased signal posteriorly (arrows) at the level of C3 in a normal-sized spinal cord. The plaque is approximately half a vertebral segment in length and is longer than it is wide. (B) Axial T2-weighted scan through the plaque shows the typical peripheral posterolateral location in cross section (arrow). Note that the plaque involves less than half the cross-sectional area of the cord. (C) Axial proton-densi...
Fig SP 22-2. Multiple sclerosis. (A) Sagittal T2-weighted image shows focal increased signal posteriorly (arrows) at the level of C3 in a n...
Figure 9.74. B: The magnetic resonance scan shows a demyelinating plaque that crosses the midline at the brainstem, accounting for bilateral median longitudinal fasciculus lesions.
Figure 9.74. B: The magnetic resonance scan shows a demyelinating plaque that crosses the midline at the brainstem, accounting for bilater...
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