Multiple sclerosis: diagnostic issues and modern management

Sian E Price

doi:10.22599/bioj.2

Abstract

Aim: To provide an insight into the current issues in the diagnosis and management of multiple sclerosis (MS). Methods: A literature-based review was undertaken to determine diagnostic criteria, differential diagnosis, and the use of disease-modifying medication and symptomatic treatments for MS. The main source of references was Medline via PubMed but standard major reference works on MS were also used. Results: The prevalence of MS may be increasing, especially in women, thereby increasing the need for resources for diagnosis and clinical management of the condition. Clinical diagnosis of MS has changed little since the descriptions of Charcot. However, new diagnostic techniques ranging from neurophysiology and spinal fluid analysis to increasingly sophisticated magnetic resonance imaging have allowed the condition to be diagnosed earlier and with more confidence. New insights in immunology and neuropathology allow differential diagnoses to be excluded and continue to lead to different approaches to managing the condition. New disease-modifying drugs are being used, with the realistic hope of altering the progression of disability. Equally important are new techniques and medications aimed at symptom management, ranging from multidisciplinary team working to drug treatment of pain, fatigue, spasticity, continence and nystagmus. Conclusions: There is continuing improvement in many aspects of the care of people with MS. Insights from epidemiology, genetics, pathology and clinical trials have all contributed to this.

Highlights

Multiple sclerosis (MS) is a chronic life-changing condition
The review will highlight the incidence of MS in Britain and Ireland, the current diagnostic criteria and differential diagnosis, and the use Correspondence and offprint requests to: Dr Sian Price, Department of Neurology, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF. e-mail: sian.price@sth.nhs.uk of disease-modifying medication and symptomatic treatments
The main source of references was Medline via PubMed, but standard major reference works on MS were used

Summary

Introduction

MS is common, with the British Isles having one of the highest prevalence levels in the world, ranging from 87–113/100 000 in the Channel Islands in the south to 309/100 000 (257 ‘probable’ category) in the Orkneys in the north in the 1970s.1,2 Prevalence is patchy, with studies in adjoining areas performed by the same team giving quite different levels: for example, 119/100 000 and 152/100 000 in north and south Cambridgeshire, respectively, in 1996.3,4 More recently levels of 230.6/ 100 000 (200.5 standardized to 1961 population demographics) have been recorded in Northern Ireland.[5]. These oligoclonal bands are found in more than 95% of patients with clinically definite disease They are useful where MRI has shown non-specific, possibly vascular lesions, where symptoms and signs are typical but MRI uninformative, or in progressive syndromes such as PPMS presenting with a progressive spastic paraparesis.[48,49]. Optic neuritis is one of the most common acute optic neuropathies in the under-forties.[50] This classically presents with acute visual loss over days, pain (in 90% of cases, often on eye movement), loss of colour vision and evidence of field defects (classically central, but can be any); about one-third of cases will have disc swelling (Fig. 3).[50,51] Severity is often reflected in the length of the optic nerve lesion seen on MRI. Clinical examination reveals reduced adduction or a subtle lag of

Method of diagnosis

Findings

Conclusions