Multiple Sclerosis

Multiple Sclerosis

Multiple sclerosis (MS) is a disease affecting the central nervous system. It causes serious damage to the myelin and the axon resulting in physical disability in more than 30 percent of the patients within 25 years of its onset. An immune-mediated inflammatory disease, MS symptoms may appear in intervals -- months or years apart -- and affects different parts of the body.

Signs and symptoms
The main signs and symptoms of MS are:
• Sensory loss (ie, paresthesias), an early sign
• Pain
• Optic neuritis
• Heat intolerance
• Cognitive difficulties: regarding attention span, concentration, memory and judgment
• Spinal cord symptoms (motor): cramping muscles, secondary to spasticity
• Spinal cord symptoms (autonomic): Bowel, Bladder and sexual dysfunction
• Cerebellar symptoms: Charcot triad of dysarthria, ataxia, and tremor
• Facial myokymia (irregular twitching of the facial muscles)
• Eye symptoms: Including diplopia on lateral gaze
• Trigeminal neuralgia: Bilateral facial weakness or trigeminal neuralgia
• Depression
• Constitutional symptoms: Especially fatigue and dizziness
• Euphoria
• Bipolar disorder or frank dementia
• Symptoms associated with partial acute transverse myelitis


Tests to diagnose Multiple Sclerosis include:
• MRI -- confirms MS and monitors progress
• Evoked potentials: This technique is used to find out if there are any subclinical lesions
• Lumbar puncture: Comes in handy when MRI is not available or if MRI findings prove inconclusive. CSF is evaluated for oligoclonal bands and intrathecal immunoglobulin G (IgG) production


Different categories of MS are:

• Relapsing-remitting MS (RRMS)
• Primary progressive MS (PPMS)
• Secondary progressive MS (SPMS)
• Progressive-relapsing MS (PRMS)

There are two subgroups under RRMS
• Clinically isolated syndrome (CIS)
• Benign MS: The patient may experience a remission; but the disease will come back. Some patients may not experience any remission at all.


Immunomodulatory therapy (IMT) is employed for treating the immune disorder that causes the MS. The symptoms are treated using medications.

The treatment includes:
• Methylprednisolone (Solu-Medrol) - for quick recovery from an acute exacerbation of MS
• Plasma exchange (plasmapheresis) - short-term use is effective if steroids are contraindicated
• Dexamethasone - for treating acute transverse myelitis and acute disseminated encephalitis

Disease-modifying agents for MS (DMAMS) are used when there is a relapse.

Here's a list of approved DMAMS medications:
• Interferon beta-1a (Avonex, Rebif)[10]
• Interferon beta-1b (Betaseron, Extavia)[11]
• Natalizumab (Tysabri)[13, 14]
• Glatiramer acetate (Copaxone)[12]
• Teriflunomide (Aubagio)[17]
• Fingolimod (Gilenya)[16]
• Dimethyl fumarate (Tecfidera)[1, 2, 3, 4]
• Mitoxantrone[15]

Patients may use a single-use autoinjector to administer interferon beta-1a (Rebif) if there is a relapse.

The following agents may be used :
• High-dose cyclophosphamide (Cytoxan) -- for induction therapy
• Mitoxantrone -- to treat neurologic disability and/or reduce the frequency of clinical relapses in patients with PRMS, SPMS or worsening RRMS

The following conditions may be treated using drugs:
• Depression: serotonin reuptake inhibitors
• Sexual dysfunction: Oral phosphodiesterase type 5 inhibitors (eg, sildenafil, tadalafil, vardenafil)
• Fatigue - amantadine, methylphenidate, and fluoxetine
• Optic neuritis: Intravenous methylprednisolone
• Spasticity: Baclofen
• Pain: Tricyclic antidepressants

Dr. Sanjiv C.C is a senior neurologist who is an expert in Parkinsons diagnosis and management. He is available for consultation in the city of Bangalore at Apollo Hospital, Jayanagar.

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