Multiple Sclerosis
Summary
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. It presents with episodes of neurological dysfunction (relapses) separated in time and space, or progressive disability. Diagnosis uses McDonald criteria requiring dissemination in space (DIS) and time (DIT). Disease-modifying therapies (DMTs) reduce relapse rate and disability progression.
Key Facts
- Definition: Chronic inflammatory demyelinating CNS disease
- Incidence: 5-7 per 100,000 per year
- Pathognomonic: Multiple CNS lesions disseminated in space and time
- Gold Standard Investigation: MRI brain/spine + CSF (OCBs)
- First-line Treatment: DMTs for RRMS; steroids for acute relapses
- Prognosis: Variable; DMTs significantly improve outcomes
Clinical Pearls
McDonald Pearl: DIS + DIT on MRI can diagnose MS from single presentation.
OCB Pearl: Oligoclonal bands in CSF support diagnosis but not required.
Relapse Pearl: Treat with methylprednisolone 1g x3-5 days; speeds recovery.
| Type | Features |
|---|---|
| RRMS | Relapses with recovery/partial recovery |
| SPMS | Progressive after initial RRMS |
| PPMS | Progressive from onset |
| CIS | Clinically isolated syndrome |
Algorithm
Acute Relapse
- IV methylprednisolone 1g daily x3-5 days
Disease-Modifying Therapies
| Category | Examples |
|---|---|
| Platform | Interferon-beta, glatiramer acetate |
| Oral | Dimethyl fumarate, teriflunomide, fingolimod |
| High efficacy | Natalizumab, ocrelizumab, alemtuzumab |
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Thompson AJ et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-173. PMID: 29275977
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NICE guideline NG220. Multiple sclerosis. 2022.
Viva Points
"MS: DIS + DIT. McDonald criteria. Types: RRMS, SPMS, PPMS. Relapses: IV methylpred. DMTs reduce relapses and progression."
Last Reviewed: 2026-01-01 | MedVellum Editorial Team