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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify risk factors for multiple sclerosis (MS).

  2. Describe pathophysiologic findings of MS.

  3. Distinguish between the forms of MS based on patient presentation and course of disease.

  4. Compare and contrast MS disease-modifying treatment choices for a specific patient.

  5. Determine appropriate symptomatic treatment choices and develop a detailed therapeutic plan for a specific patient.

  6. Develop a monitoring plan for a patient placed on specific medications.

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KEY CONCEPTS

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  • Image not available. Multiple sclerosis (MS) symptoms depend on the location of lesions within the central nervous system (CNS).

  • Image not available. MS has four clinical patterns: relapsing remitting, secondary progressive, primary progressive, and progressive relapsing.

  • Image not available. The McDonald criteria, using clinical examination in combination with magnetic resonance imaging (MRI) data, facilitates earlier diagnosis and thus earlier treatment initiation.

  • Image not available. Acute relapses are treated with corticosteroids to speed recovery.

  • Image not available. Disease-modifying therapies decrease the number of relapses, prevent permanent neurologic damage, and prevent disability.

  • Image not available. Symptomatic treatment minimizes the impact of MS on quality of life.

  • Image not available. Dose–response curves have been observed with the β-interferons.

  • Image not available. There is no consensus on the best medication for initial therapy.

  • Image not available. Mitoxantrone and natalizumab should be reserved for patients with rapidly advancing disease who have failed other therapies.

  • Image not available. MS patients must be treated with agents specific for upper motor neuron spasticity.

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Multiple sclerosis (MS) is an inflammatory disease of the CNS, variable in symptoms and presentation. Multiple describes the number of CNS lesions, and sclerosis refers to the demyelinated lesions, today called plaques.

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EPIDEMIOLOGY AND ETIOLOGY

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Epidemiology

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Approximately 400,000 Americans have MS.1 Diagnosis usually occurs between the ages of 20 and 50. Twice as many women as men develop MS.1 Whites and people of northern European heritage are more likely to have MS.2 Risk factors for MS include family history of MS, autoimmune diseases, or migraine; personal history of autoimmune diseases or migraine; and, in women, smoking and exposure to secondhand smoke. Prevalence decreases with decrease in latitude.2

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Etiology

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Inheritance Theory
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MS probably has a genetic component, likely carried in the human leukocyte antigen chromosomal region. Family members of MS patients have a 5% risk; monozygotic twins have a concordance rate of 25% to 30%.2 A straightforward inheritance pattern cannot fully explain the etiology of MS because only a small proportion of patients report a family member with MS.

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Environment Theory
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Currently, human herpes virus 6, herpes zoster virus, or Epstein-Barr virus are thought to be possible infectious etiologic agents.3 Infection with these viruses cannot fully explain MS because there is a high rate of seropositivity in the population, but MS is much less common. Another theory involves decreased sunlight exposure. Lower serum concentrations of 25-hydroxyvitamin D are associated with higher ...

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