4 main types:
- relapsing-remitting
- accounts for 80% of cases
- secondary progressive
- up to 50% of relapsing-remitting patients eventually develop this
- primary progressive
- 10-15% of cases
- older age of onset
- progressive-relapsing
Initial presentation tends to be a single symptom, such as:
- optic neuritis
- pain on eye movement and rapid deterioration in central vision, loss of colour vision
- treatment is methylpred
- single episode gives 40-60% chance of subsquent MS
- numbness or tingling in limbs
- leg weakness
- ataxia
Diagnosis is by (NB none is specific):
- lesions disseminated in time and location
- T2 weighted MRI showing demyelinating plaques
- delayed visual evoked response potentials
- oligoclonal bands in CSF but not serum
Good prognostic factors are:
- relapsing-remitting course
- female
- young onset
- sensory symptoms
Risk of MS is increased 20-40% in siblings and there is 25% concordance in monozygotic twins.
Treatment is:
- IV methylprednisolone
- shortens relapses
- no effect on incidence of attacks
- beta interferon
- decreases relapses by 30%
- given if
- relapsing-remitting course and 2 relapses in 2 yrs and can walk 100m unaided
- secondary progressive and 2 relapses in 2 yrs and 100m aided
- side effect: flu-like
- baclofen
- decreases spascity
Now for the less heavy-going Menieres disease...
