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Central Nervous System Disorders
 
Central Nervous System Disorders
 

Multiple Sclerosis

 
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Pathogenesis

    • Risk Factors for Multiple Sclerosis

    • Female sex
    • Family history of multiple sclerosis
    • High lattitude (further from equator)
    • EBV infection
    • Smoking

Manifestations

    • Clinical Phenotypes

    • Clinically isolated syndrome - a single episode of symptoms
    • Relapsing-remitting - relapses with improvement between episodes
    • Primary progressive - progression without relapses
    • Secondary progressive - progressive disability with fewer relapses and no return to baseline between episodes

Diagnosis

    • Signs of Multiple Sclerosis

    • Signs of optic neuritis - reduced visual acuity, central visual loss, optic disc atrophy
    • Internuclear ophthalmoplegia - inability to adduct one eye, with nystagmus in the other eye
    • Lhermitte’s sign - electric sensation in the limbs on neck flexion
    • Upper motor neuron weakness - increased tone, reduced power, hyperreflexia
    • Dorsal column (vibration / proprioception) sensory loss
    • Signs of cerebellar involvement - ataxia, dysarthria, dysmetria, dysdiadochokinesis, nystagmus

Management

    • Management Options for Multiple Sclerosis

    • Non-Pharmacologic

    • Smoking cessation
    • Vitamin D supplementation
    • Exercise
    • Weight loss
    • Pharmacologic

    • Beta interferon
    • Glatiramer acetate
    • Teriflunomide
    • Fingolimod
    • Cladribine
    • Natalizumab
    • Ocrelizumab
    • Alemtuzumab
    • Advanced Therapy

    • Autologous stem cell transplant
  •  
    Neurologic Drugs
 
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