Multiple sclerosis
| Incidental findings | |
| +ve signs | Spastic paraparesis, cerebellar signs ± optic atrophy in young female |
| Differential diagnosis | ‘demyelinating disease’ |
| Function | |
| Tests |
Vitamin B12 to exclude subacute degeneration MR brain – hyperintense focal perventricular white matter lesions on T2 weighted LP – ↑Total protein, oligoclonal bands Serum electrophoresis – to exclude oligoclonal bands in serum |
Extensions
- Ask to do fundoscopy for optic atrophy
- Look for INO with fist / hand method
- Check for nystagmus, other cerebellar signs
Notes
- Common presentations: Optic neuritis, limb weakness, nystagmus
- Categories: Relapsing-remitting; secondary progressive; primary progressive; progressive relapsing
- Poor prognosis: progressive disease, multiple lesions on MR, freqeunt relapses first 2 years
- IV methylpred given to speed recovery in relapses, however no evidence for long term benefit.
- Interferon beta (1a/1b) reduces the relapse rate in relapsing/remitting by one third. Indicated for ambulant patients with at least 2 relapses in previous 2 years with recovery.