Multiple sclerosis Diagnosis, management and prognosis

Discussion

Multiple sclerosis usually starts with an acute episode of neurological disturbance, termed a ‘clinically isolated syndrome’, followed by an illness phase punctuated by relapses and remissions which may transition after 10 years to a phase of progressive accumulation of disability without relapses. Fifteen to 20% of patients will have a progressive course from the onset. There is significant interpatient variability in prognosis. The main diagnostic criteria are clinical, supported by investigations including magnetic resonance imaging and lumbar puncture and evoked potentials. First line disease modifying agents for relapsing remitting multiple sclerosis include interferon-ß and glatiramer. First line treatment for relapses is usually intravenous methylprednisolone for 3 days. Troublesome symptoms may include spasticity, parasthesias, tremor, erectile dysfunction, depression and anxiety, fatigue and pain. After excluding differential diagnoses, symptomatic management includes pharmacological agents, allied health consultation and continence strategies. Although pregnancy reduces disease activity, there is a higher risk of relapse in the postpartum period.