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multiple sclerosis

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Multiple sclerosis is a chronic inflammatory autoimmune disorder of the central nervous system which constitutes the most common cause of neurological disability in young adults.

  • multiple sclerosis (MS) is an acquired chronic immune-mediated inflammatory condition of the central nervous system (CNS), affecting both the brain and spinal cord. It affects approximately 100,000 people in the UK. It is the commonest cause of serious physical disability in adults of working age (1,2,3)
  • people with MS typically develop symptoms in their late 20s, experiencing visual and sensory disturbances, limb weakness, gait problems, and bladder and bowel symptoms. They may initially have partial recovery, but over time develop progressive disability

Typically a disease of young adults, the diagnosis depends on the detection at least two demyelinating lesions in the brain or spinal cord separated in time and space. The course of the disease is characterised by relapses and remissions with some residual disability. Progressive disability may occur from the outset, but more commonly occurs after several years of relapsing and remitting disease.

  • approximately 85% of patients with multiple sclerosis present with the relapsing-remitting form, comprising episodic relapses and remissions that may be partial or complete
    • 15% of patients with relapsing-remitting multiple sclerosis have a mild course with minimal disability after 15 years, called benign multiple sclerosis (1)
    • approximately 15% of patients present without relapses but show a slowly progressive pattern called primary progressive multiple sclerosis (a few of these may later relapse, called progressive-relapsing multiple sclerosis)
    • around two-thirds of people who start with relapsing and remitting MS may develop secondary progressive MS: this occurs when there is a gradual accumulation of disability unrelated to relapses, which become less frequent or stop completely (2)
  • classification of multiple sclerosis is important as all the disease modifying drugs have shown benefit only in the relapsing-remitting type and no benefit in the primary progressive form (1)

The cause of MS is unknown. It is believed that an abnormal immune response to environmental triggers in people who are genetically predisposed results in immune-mediated acute, and then chronic, inflammation. The initial phase of inflammation is followed by a phase of progressive degeneration of the affected cells in the nervous system

Treatment aims to:

  • reduce the severity and frequency of relapses
    • possible treatment options for relapsing and remitting multiple sclerosis include beta interferon, glatiramer acetate, fingolimod, natalizumab and teriflunomide
  • limit persistent disability
  • relieve symptoms
  • promote tissue repair

Reference:

  1. Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ 2006; 332: 525-7.
  2. NICE (October 2014). Multiple sclerosis management of multiple sclerosis in primary and secondary care.
  3. NICE (January 2014). Teriflunomide for treating relapsing-remitting multiple sclerosis

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