Multiple Sclerosis: Diagnosis and Treatment

Describe the clinical features diagnostic criteria and treatment options for multiple sclerosis., What role do disease-modifying therapies play in management, and how do they differ in efficacy and mechanism of action? How does the presentation of relapsing-remitting multiple sclerosis (RRMS) differ from primary progressive multiple sclerosis (PPMS), and what are the prognostic factors influencing long-term disability?

Multiple Sclerosis: Clinical Features, Diagnosis, and Treatment

Clinical Features

• Symptoms: Common symptoms include fatigue, neurological deficits (e.g., numbness, weakness), visual disturbances, coordination and balance issues, and cognitive changes.
• Types of Symptoms: Symptoms can be relapsing (flare-ups) or progressive, affecting various body functions depending on the areas of the CNS involved.

Diagnostic Criteria

• McDonald Criteria: The diagnosis of multiple sclerosis (MS) typically follows the McDonald criteria, which include:
  • Evidence of lesions in at least two different locations in the CNS.
  • Evidence of lesions occurring at different times (dissemination in time).
  • MRI findings showing lesions consistent with MS (e.g., T2 hyperintense lesions).
• Lumbar Puncture: Analysis of cerebrospinal fluid (CSF) may show oligoclonal bands, indicating immune response in the CNS.

Treatment Options

Disease-Modifying Therapies (DMTs)

• Role: DMTs aim to modify the disease course, reduce relapse rates, and slow progression of disability.
• Types of DMTs:
  • Injectables: Interferons (e.g., interferon beta-1a) and glatiramer acetate.
  • Oral agents: Fingolimod, dimethyl fumarate, and teriflunomide.
  • Infusion therapies: Natalizumab, ocrelizumab, and alemtuzumab.

Efficacy and Mechanism of Action

• Interferons: Modulate immune response and reduce inflammation.
• Glatiramer Acetate: Mimics myelin and promotes anti-inflammatory responses.
• Fingolimod: Sphingosine-1-phosphate receptor modulator that prevents lymphocyte migration into the CNS.
• Ocrelizumab/Alemtuzumab: Target specific immune cells (B cells) to reduce autoimmune activity.

Presentation of RRMS vs. PPMS

• Relapsing-Remitting Multiple Sclerosis (RRMS):
  • Characterized by clearly defined relapses followed by periods of partial or complete recovery (remission).
  • Most common form at onset, comprising about 85% of cases. APA