- Last edited on April 30, 2020
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| ===== Primer ===== | ===== Primer ===== | ||
| - | **Multiple Sclerosis** (MS) is a chronic inflammatory disease of the central nervous system. | + | **Multiple Sclerosis** (MS) is a chronic inflammatory disease of the central nervous system, and associated with neuropsychiatric symptoms including depression. |
| - | ==== Prevalence ==== | + | == Epidemiology == |
| - | MS affects more than 2 million people worldwide. | + | * MS affects more than 2 million people worldwide |
| - | ===== Neuropsychiatric Symptoms ===== | + | == Prognosis == |
| - | MS patients have a 50% chance of developing depression. Depression in MS patients not like typical MDD - there is usually less neurovegetative symptoms. If there is a family history of MDD, there is an 80% chance of developing depression in MS. | + | * Relapsing and remitting symptoms is most common clinical course of MS |
| + | |||
| + | == Comorbidity == | ||
| + | * Individuals with MS have a 50% lifetime risk for depression.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739575/|Siegert, R. J., & Abernethy, D. A. (2005). Depression in multiple sclerosis: a review. Journal of Neurology, Neurosurgery & Psychiatry, 76(4), 469-475.]])] | ||
| + | * Depression in MS patients not like typical depression - there is usually less neurovegetative symptoms. If there is a family history of depression, there is an 80% chance of developing depression in MS. Fatigue is also a common symptom.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706287/|Chwastiak, L. A., & Ehde, D. M. (2007). Psychiatric issues in multiple sclerosis. Psychiatric Clinics of North America, 30(4), 803-817.]])] | ||
| + | * There is an increased risk for suicide.[([[https://pubmed.ncbi.nlm.nih.gov/28327056/|Feinstein, A., & Pavisian, B. (2017). Multiple sclerosis and suicide. Multiple Sclerosis Journal, 23(7), 923-927.]])] | ||
| + | |||
| + | == Risk Factors == | ||
| + | * Women between ages 20 to 30 | ||
| + | * Low serum vitamin D levels | ||
| + | * More common in those living further from equator | ||
| + | |||
| + | ===== Diagnosis ===== | ||
| + | ==== Signs and Symptoms ==== | ||
| + | MS can present with non-specific signs and symptoms including: | ||
| + | * Acute optic neuritis | ||
| + | * Painful unilateral visual loss assoiated with relative afferent pupillary defect (RAPD) | ||
| + | * [[neurology:neuro-exam:home|Abnormal neurological exam]], including brain stem/cerebellar syndromes (e.g. - diplopia, ataxia, [[neurology:approach-aphasia|ataxic dysarthria (scanning speech)]], [[neurology:approach-tremors|intention tremor]], nystagmus/INO [bilateral > unilateral]) | ||
| + | * Pyramidal tract demyelination, causing weakness and spasticity | ||
| + | * Spinal cord syndromes | ||
| + | * Electric shock-like sensations along cervical spine on neck flexion | ||
| + | * Neurogenic bladder | ||
| + | * Paraparesis | ||
| + | * Sensory changes affecting the trunk or one or more of the upper and/or lower extremity | ||
| + | * Symptoms may be exacerbated with increased body temperature such as when the individual takes a hot bath or exercises | ||
| + | |||
| + | ==== Neuropsychiatric ==== | ||
| + | * Rare cases of psychosis as an initial symptom of MS has been reported.[([[https://pubmed.ncbi.nlm.nih.gov/34927555/|Özbudak, P., Erçelebi, H., & Gücüyener, K. (2021). Psychosis: a rare onset symptom of pediatric multiple sclerosis. Neurocase, 1-3.]])] | ||
| + | ===== Pathophysiology ===== | ||
| + | * MS is thought to occur due to autoimmune inflammation and demyelination of CNS (brain and spinal cord) with subsequent axonal damage. | ||
| + | |||
| + | ===== Investigations ===== | ||
| + | ==== CSF ==== | ||
| + | * Increased IgG level and myelin basic protein in CSF. Oligoclonal bands are diagnostic. | ||
| + | |||
| + | ==== Neuroimaging ==== | ||
| + | * Neuroimaging with MRI is gold standard approach to diagnosis | ||
| + | * Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) can be seen on neuroimaging along with multiple white matter lesions | ||
| + | |||
| + | ===== Treatment ===== | ||
| + | * Disease-modifying therapies can stop relapses and halt or slow progression: | ||
| + | * β-interferon | ||
| + | * Glatiramer | ||
| + | * Natalizumab) | ||
| + | * Acute flares are treated with IV steroids | ||
| + | * Symptomatic treatment for other issues include catheterization, and muscarinic antagonists for for neurogenic bladder | ||
| + | * Baclofen, GABAB receptor agonists can be used for spasticity | ||
| + | * Tricyclic antidepressants, and anticonvulsants can be used for pain | ||
| ===== Resources ===== | ===== Resources ===== | ||
| * [[https://www.nejm.org/doi/full/10.1056/NEJMra1401483|Review Article - Longo, D. L. (2018). Multiple Sclerosis. N Engl J Med, 378, 169-80.]] | * [[https://www.nejm.org/doi/full/10.1056/NEJMra1401483|Review Article - Longo, D. L. (2018). Multiple Sclerosis. N Engl J Med, 378, 169-80.]] | ||