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Central Nervous System Disorders
Central Nervous System Disorders

Multiple Sclerosis



  • Risk Factors for Multiple Sclerosis

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


  • 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


  • 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 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
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