Multiple Sclerosis

Dr Bhupendra ShahAssistant ProfessorB.P. koirala Institute of Health Sciences

Beautiful movie………..

MULTIPLE SCLEROSIS

WHERE IS MULTIPLE SCLEROSIS?

PATHOPHYSIOLOGY OF MULTIPLE SCLEROSIS

Clinical features:

Few interesting symptoms…

• Uhthoff’s phenomenon

• Lhermitte’s symptoms

VARIANTS OF MULTIPLE SCELEROSIS

PROGRESSIVE RELAPSING

SECONDARY PROGRESSIVE

PRIMARY PROGRSSIVE

RELAPSING AND REMMITING

INVESTIGATION

PLAQUE

MRI in Multiple Sclerosis

CSF IN MULTIPLE SCELOROSIS

MC DONALD CRITERIA FOR MULTIPLE SCLEROSIS

ATTACK CLINICAL LESION

REQUIREMENT

2 2 None

2 1 Dissemination is space by MRI(in different areas)

1 2 Dissemination in time by MRI(different lesion new and old)

1 1 Dissemination in space and time

TREAMENT

• Acute exacerbation usually in relapsing and remmiting variants

• Shorter course

Symptomatic managmentPROBLEM DRUGS

Spasticity Physiotherapy, muscle relaxant

Ataxia Isoniazide, clonazepam

Dystheisia Carbamazepine, amitriptyline

TAKE HOME MESSAGE

• inflammatory disease of white matter of CNS .

• Shows relapsing and remmiting pattern

• MRI is choice of investigation

• Immunomodulator is a drug of choice .