Multiple Sclerosis Question Answers - All Explained

How common is multiple sclerosis?
The prevalence is about 1 in 800 people, with an annual incidence of 2-10 per 100 000. The age of onset varies but peaks between 20 and 40 years of age.

What are the main ways in which multiple sclerosis can present?
· Optic neuritis (in 40% of cases) resulting in partial loss of vision.
· Weakness of one or more limbs.
· Tingling in the extremities due to posterior column involvement.
· Diplopia.
· Nystagmus, cerebellar ataxia.
· Vertigo.

What is the natural history of multiple sclerosis?
The course of the disease is extremely variable and patients with multiple sclerosis tace enormous prognostic uncertainty. The onset may be acute, subacute or insidious. The course may be rapidly downhill, or may spontaneously remit for periods lasting from days to years before a second exacerbation.

What are the clinical categories of multiple sclerosis?
· Relapsing-remitting: episodes of acute worsening with recovery and a stable course between relapses.
· Secondary progressive: gradual neurological deterioration with or without super-imposed acute relapses in a patient who previously had relapsing-remitting multiple sclerosis.
· Primary progressive: gradual, almost continuous neurological deterioration from the onset of symptoms.
· Progressive relapsing: gradual neurological deterioration from the onset of symptoms but with subsequent superimposed
relapses.

Does pregnancy affect the clinical features of multiple sclerosis?
Pregnancy itself may have a mildly protective effect but there is an increased risk of relapse during the puerperium; overall, the effect on the course of the disease is probably negligible.

What are the prognostic markers that predict more severe multiple sclerosis ?
· Progressive disease from the onset of symptoms.
· Frequent relapses in the first two years.
· Motor and cerebellar signs at presentation to neurologist.
· Short interval between the first two relapses.
· Male gender.
· Poor recovery from relapse.
· Multiple cranial lesions on T2-weighted MRI at presentation.