Return

Múltiple sclerosis

  1. The most common autoimmune inflammatory demyelinating disease of the central nervous system (CNS).
    The typical patient presents as a young adult with two or more clinically distinct episodes of CNS dysfunction with at least partial resolution.

    Symptoms and signs
    The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. In the worst cases, can produce partial or complete paralysis. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings. Some may also experience pain, speech impediments, tremors, and dizziness are other frequent complaints. Approximately half of all people with MS experience cognitive impairments, but such symptoms are usually mild and are frequently overlooked. Depression is another common feature of MS.



    Disease severity
    Benign MS. The patient remains fully functional in all neurologic systems 15 years after the disease onset.
    Malignant MS. Refers to disease with a rapid progressive course, leading to significant disability in multiple neurologic systems or death in a relatively short time after disease onset.

    Diagnosis
    Multiple sclerosis (MS) is a clinical diagnosis. Investigative studies such as magnetic resonance imaging (MRI), evoked potentials, and spinal fluid analysis are often needed to confirm the diagnosis and exclude other possibilities.

    Management
    Five disease-modifying treatments for multiple sclerosis have been approved by the FDA. These treatments are partially effective in reducing exacerbations and may slow progression of disability.
    While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients.

    Symptom-specific drugs can relieve spasticity, bladder dysfunction, depression, pain and fatigue.
    Spasticity is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene.
    Other drugs that may reduce fatigue in some, but not all patients include amantadine, pemoline and modafinil. Oxybutynin and tolterodine are a first-line treatment for bladder dysfunction. Paroxysmal attacks typically respond to low doses of anticonvulsants such as gabapentin and carbamazepine.

    Physical therapy and exercise can help preserve remaining function, and patients may find that various aids (foot braces, canes, and walkers) can help them remain independent and mobile. Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue. If psychological symptoms of fatigue such as depression are evident, antidepressant medications may help

    Reference: Olek M. Diagnosis of multiple sclerosis in adults. Available at: Up To Date, version 17.1. Current through January 2009. NINDS (National Institute of Neurological Disorders and Stroke). Internet. Accessed January 25, 2011. Available at: http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm. Calabresi P. Diagnosis and management of multiple sclerosis. Am Fam Physician 2004;70(10):1935-1944.