Disease modifying treatment available:
Time critical diagnosis and management:
Lateralising:
The exact aetiology of multiple sclerosis is not known. There is evidence both genetic and environmental factors play a role.
The concordance rate of monozygotic twins is around 30%, compared to around 5% for dizygotic twins. The risk of developing the condition with a first degree relative is around ~3-5%. Genome wide association studies have shown associations between several major histocompatibility complex (MHC) alleles and MS, suggesting that immune dysfunction is associated with the disease.
Evidence that environmental factors are involved in the pathogenesis of MS comes in several forms:
1) The incomplete concordance observed in monozygotic twins
2) Geographical variance
3) Migration studies - individuals who migrate prior to adolescence adopt the risk of the area they migrate to.
Several viruses have been postulated to play a role in MS pathogenesis - most notably Epstein-Barr virus.
Vitamin D may play a role.
Smoking appears to increase risk.
Multiple sclerosis may cause the following:
| Laboratory Investigation | Result |
|---|
First line management of a relapse is with glucocorticoids. Methylprednisolone 500mg orally for 5 days is used for moderate-to-severe disease flares. RCTs have demonstrated administration of steroid reduces the chance of worsening or not improving at 5 weeks. RCTs have not shown any significant difference in oral versus IV treatment. Plasma exchange is an alternative.