Multiple sclerosis (MS)

• Disseminated sclerosis

• 340 Multiple sclerosis

• G35 Multiple sclerosis

• 4C: Impaired Muscle Performance
• 5E: Impaired Motor Function and Sensory Integrity Associated With Progressive Disorders of the Central Nervous System
• 6B: Impaired Aerobic Capacity/Endurance Associated With Deconditioning
• 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated With Airway Clearance Dysfunction
• 6E: Impaired Ventilation and Respiration/Gas Exchange Associated With Ventilatory Pump Dysfunction or Failure

Description

• Chronic disease
• Progressive disorder characterized by demyelination (or demyelinating plaques) in the central nervous system attacking the brain, spinal cord, and optic nerves
• The disease process causes areas of inflammation, lesions, in random and unpredictable areas of the central nervous system. The inflammation leads to irreversible axonal damage and scarring that interferes with nerve impulse

Essentials of Diagnosis

• Etiology is unknown
• Episodic neurologic symptoms
• Usually under 55 years of age at onset1
• Single pathologic lesion cannot explain clinical findings
• Multiple foci best visualized by MRI

General Considerations

• Diagnosis of clinically definite disease can be made when there is dissemination of symptoms in time and space
  • Time: any new lesion in the central nervous systems in a follow-up MRI
  • Space: one or more lesions identified in two distinct locations in the central nervous system
• The diagnosis is probable in patients with multifocal white matter disease, but only one clinical attack
• Four categories of the disease
  • Relapsing/remitting: clearly defined relapses, or episodes of loss of function, followed by relative recovery
  • Primary progressive: continuous decline in function, not interrupted by plateaus or periods of faster decline/relapse
  • Secondary progressive: begins as relapsing/remitting, and later becomes slow progressive decline without periods of remittance
  • Progressive Relapsing: continuous decline with periods of faster decline/relapse, time between relapses shows progressive decline

Demographics

• 90% of people with MS are diagnosed between the ages of 16 and 60 years; more common in women (2.5:1)
• Much more common in persons of Western European lineage who live in temperate zones
• No population with a high risk for multiple sclerosis exists between latitudes 40 ˚N and 40 ˚S1
• Genetic susceptibility to the disease is possible based on twin studies, familial cases, and an association with specific Human Leukocyte Antigen (HLA) antigens (HLA-DR2)

Signs and Symptoms

• Symptoms may develop quickly (within hours) or over days/weeks
• Most common initial symptoms
  • Fatigue
  • Incoordination
  • Speech disturbances
  • Motor weakness
  • Paresthesia
  • Difficulty with walking
  • Vision difficulties (most commonly diplopia)
  • Tremor
  • Bowel and/or bladder dysfunction
• Less common initial presentations
  • Hemiplegia
  • Trigeminal neuralgia
  • Facial palsy
• Other signs and symptoms as the disease progresses
  • Spasticity and reflex spasm
  • Contractures
  • Cerebellar and bulbar symptoms
  • Sensory symptoms
    • Numbness
    • Musculoskeletal pain
    • Paresthesia
    • Dysesthesia
    • Distortion of superficial sensation
  • Visual symptoms
    • Decreased acuity
    • Scotoma
    • Ocular pain
  • Sexual symptoms
    • Impotence
    • Decreased genital sensation
    • Decreased genital lubrication
  • Emotional and cognitive symptoms
    • Depression
    • Lability
    ...