1. monophasic (optic neuritis w/lesions - 10%)

2. relapsing-remitting dx (most common - 80%)

3. primary progressive (10%)

oligoclonal banding of IgG

mild leukocytic cytosis, ↑ protein

(exclude infectious dz, Lyme dz, neurosyphilis and malignancies)

1. tingling, burning, tightness, numbness

2. balance & gait abnormalities - pt trips all the time

3. bladder urgency/frequency

4. reduced vibratory sensation prior to proprioceptive loss (b/c post column is heavily myelinated)

1. dbl vision

2. useless hand

3. trigeminal neuralgia in people <50

4. sxs induced by heat or exercise

5. postpartum sxs onset

6. diurnal fatigue sxs

7. Lhermitte sign - electric like sxs that radiates down spine w/flexion of neck

8. young man that presents w/acute urinary retention

1. optic nerve involvement

2. ocular movement abnrmalities

3. corticospinal pathways abnormalities

4. somatosensory pathway abnormalities

5. cerebellar finidings (late in dx)

1. Ataxia: wide gait, walks like they are drunk

2. dysmetria: under (hypometria)/over (hypermetria) -shooting the intended position w/the hand, arm, leg or eye

3. intention tremor

1. lessend visual acuity

2. central scotoma

3. optic nerve pallor (optic atrophy)

4. impaired color vision

5. afferent pupillary defect (direct response to light is slow in affected eye OR pupil dilates NOT constricts upon second light stimulation in affected eye)

1. nystagmus (if brainstem & cerebellum are involved)

2. ophthalmoparesis (paralysis, usu partial, of ey movements)

3. indicate brainstem & cerebellar involvement

4. eye ipsalateral to lesion cannot adduct

5. contralateral eye can abduct & has horizontal nystagmus

1. Hyerpactive reflexes

2. spasticity (passive ROM difficult)

3. extensor plantar reflexes ( Babinski)

4. Clonus

5. loss of superficial reflexes

1. evoked potentials 

2. CSF analysis (increased IgG & oligoclonal bands)

1. sensory or optic neuritis at beginning of dx

2. infrequent attacks during first few years w/good recovery

1. age @ onset>40

2. male

3. progressive dx from onset

4. early cerebellar sxs (if gait ataxia is 1st sxs)

5. >4 atttacks in first 2 years

6. short intrvals btwn attacks

7. permanent disability w/in 3yrs from onset of sxs

1.Absence of gadolinium enhancing lesions is a favorable sign in a pt w/relapsing-remitting MS

2. # of lesions is proportional to the chance of relapse

Dx Modifying therapy (should be started early):

1. Interferon beta-1b (Betaseron)& Interferon beta-1a (Avonex): inhibit cell-mediated inflammation

2. Glatiraner acetate (Copaxone): inhibits Tcell recognition of myelin antigens

1. flu-like sxs common in first few mths (> in beta1-b)

2. depression (> beta1-b)

1. well-balance diet

2. no smoking

3. no excessive EtOH

4. fitness program to combat fatigue

5. counseling for depression!!!

Corticosteroids: 

1. Methylprednisolone (IV) 3-5d 500-100mg over 2-3hrs - for VERY BAD relapses

2. Prednisone (po taper): 60mg/d, decreasing by 10mg/2-3d after IV therapy - This is ONLY if you KNOW pt or post-IV

1. SSRIs

2. low dose amytiptyline (Elavil) - is good for pathological emotional incontinence

What is the most common sxs of a pt w/MS (not most common presenting sxs)

Amantadine (symmetrel)

Pemoline (Cylert)

fluoxetine (Prozac)

1. regular stretching & exercise

2. frequent voiding of bladder or bowel

3. decrease chances of infection

4. Meds: baclofen (a GABA precursor), GABA, Anticonvulsants (depakote, klonopin) or periactin (antihistamine)

1. no EtOH/caffeine

2. increase fluid intake

3. kegel exercises

4. frequent scheduled voiding

5. Ditropan (anticholinergic) 5mg, 3-4/d

6. Intermittent cath for pts w/lrg postvoid residual volume

1. lupus - pull ANA to r/o connective tissue dx

2. syphilis - pull FTA-ABS 

3. sarcoid - pull CXR to look for hilar adenopathy

4. MS

5. viral , bacterial , fungal inflammatory disorders

IV steroid speeds recovery of visual loss

Note: PO prednisone is ineffective & can increase risk for new episodes