Multiple Sclerosis

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Multiple Sclerosis

NIH - Medical Encyclopedia Multiple Sclerosis

"Multiple sclerosis (MS) usually affects woman more than men. The disorder most commonly begins between ages 20 and 40, but can strike at any age. The exact cause is not known, but MS is believed to result from damage to the myelin sheath, the protective material which surrounds nerve cells. It is a progressive disease, meaning the damage gets worse over time. Inflammation destroys the myelin, leaving multiple areas of scar tissue (sclerosis). The inflammation occurs when the body's own immune cells attack the nervous system. The inflammation causes nerve impulses to slow down or become blocked, leading to the symptoms of MS. Repeated episodes, or flare ups, of inflammation can occur along any area of the brain and spinal cord."

Highlighted Article

The role of MRI in the diagnosis of multiple sclerosis. (Adv Neurol. 2006)

"There is no single test that is diagnostic of MS, including MRI. The lesions detected with MRI are pathologically nonspecific. The principles of MS diagnosis are based on showing dissemination of white matter lesions in space and time. … The first important role for MRI in the diagnosis of MS allows for an early diagnosis of MS … The second important role for MRI in the diagnostic work-up of suspected MS patients is to rule out alternative diagnoses obvious on MRI, such as spinal stenosis and most brain tumors. Characteristic lesions that favor MS include Dawson Fingers, ovoid lesions, corpus callosum lesions, and asymptomatic spinal cord lesions. However, other white matter diseases can have similar appearances on MRI. … MRI evidence plays a supportive role in what is ultimately a clinical diagnosis of MS, in the appropriate clinical situation, and always at the exclusion of alternative diagnoses."

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Multiple Sclerosis

Diagnosis, Imaging, and Screening

NEWS:

Brain scans show hints of MS years before symptoms “Brain scans using magnetic resonance imaging may be able to detect signs of multiple sclerosis long before symptoms of the disease appear, U.S. researchers said on Wednesday. They said nearly a third of people who showed signs of the disease on brain MRIs developed the disease within five years. Multiple sclerosis occurs when the immune system attacks the myelin sheath protecting nerve cells. It affects 2.5 million people globally and can cause symptoms ranging from vague tingling to blindness and paralysis.“

Predicting Multiple Sclerosis Progression By MRI

Risk of MS Low After Optic Neuritis If MRI Is Normal “If initial brain magnetic resonance imaging (MRI) findings are normal, the odds of developing multiple sclerosis (MS) after an acute episode of optic neuritis are only 25%, results of a 15-year, prospective follow-up study indicate. The risk is lowest if features of optic neuritis are atypical, the investigators report in the June Archives of Neurology, suggesting that prophylactic treatment can safely be withheld in the absence of other neurologic symptoms.”

ARTICLES:

Diagnosing MS

JOURNAL ARTICLES:

A 3-year diffusion tensor MRI study of grey matter damage progression during the earliest clinical stage of MS. (J Neurol. 2008) “CONCLUSIONS : In patients with clinically isolated syndrome suggestive of MS, GM damage begins to accumulate during the initial stage of the disease, possibly as a consequence of GM lesion accumulation. The magnitude of such a damage does not seem to be associated with the concomitant clinical activity.”

Axonal loss was detected not only in MS eyes with a previous acute optic neuritis, but also in MS eyes with no known optic neuritis episode. Structural abnormalities correlate with functional assessments of the optic nerve. (Multiple Sclerosis 2008) “Axonal loss was detected not only in MS eyes with a previous acute optic neuritis, but also in MS eyes with no known optic neuritis episode. Structural abnormalities correlate with functional assessments of the optic nerve.”

Comorbidity delays diagnosis and increases disability at diagnosis in MS (Neurology 2008)

Gray matter atrophy in multiple sclerosis: A longitudinal study (Annals of Neurology 2008)

The Multiple Facets of Multiple Sclerosis (Amer. Orthoptic Jrnl. 2007) “Results: Motiltiy disorders included exophoria, unilateral Internuclear Ophthalmoplegia (INO), esophoria, and various types of nystagmus. The majority of nonmotility ophthalmic entities included optic neuritis, RAPD, and abnormal nerve fiber layer studies. Most patients were diagnosed based on white matter lesions on the MRI and oligoclonal bands in the spinal fluid after lumbar puncture. The majority of systemic signs were numbness, Uhthoff sign, and balance difficulties. Thirty-four percent of the patients were helped with either convergence therapy, prisms for all kinds of diplopia, and field manipulation. Conclusions: MS is a multi-factorial entity. It is important to emphasize how important a few extra history questions are, including: any pain with eye movement, any bouncing of the images, and is vision or balance any worse in the heat? The Visual Evoked Potential (VEP) and nerve fiber layer studies are important in the diagnosis of MS. Seventy percent of patients with had eye complaints as their initial symptom. “

Unexpected multiple sclerosis: follow-up of 30 patients with magnetic resonance imaging and clinical conversion profile. (J Neurol Neurosurg Psychiatry. 2008)

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