Multiple sclerosis: diagnosis and the management of acute relapses

Abstract

Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system that may result in a wide range of neurological symptoms and accumulating disability. Its course is unpredictable resulting in a changing pattern of clinical need. Diagnostic criteria for multiple sclerosis require objective evidence for dissemination in space and time. The diagnostic and management process should follow good practice guidelines with the person at the centre of the process. Appropriate support and information should be available from the time of diagnosis. Continuing education is key in enabling the person to actively participate in their management. In the event of an acute relapse the person should have direct access to the most appropriate local service. Provided medical causes have been excluded, corticosteroid treatment to hasten the recovery from the relapse should be considered. Management of an acute relapse should be comprehensive addressing any medical, functional, or psychosocial sequelae.

The Diagnosis of Multiple Sclerosis

“…The actual deficits can be quite variable, but commonly include sensory disturbances, unilateral painless loss of vision, double vision, weakness of limbs, unsteadiness of gait, and bowel or bladder symptoms [1][2][3][4]. The symptoms can be localized to a single plaque or multiple concurrent plaques of demyelination.…”

“…The formal diagnosis of MS requires clinical evidence of multiple CNS lesions disseminated over space and time [1][2][3][4][5][6]. For a "typical" presentation characterized by abrupt onset of temporally discrete focal neurological symptoms, a definite diagnosis may be relatively easy.…”

“…Magnetic resonance imaging (MRI) has rapidly become the primary adjunctive modality in the diagnosis of MS [1][2][3][4][5][6][7][8][9][10]. MRI can very reliably detect the white matter abnormalities seen in MS.…”

“…In addition, MRI with gadolinium as a contrast agent can be extremely useful. Plaques that show enhancement with gadolinium are typically thought to be active MS lesions, with ongoing destruction of the blood-brain barrier [4][5][6][7][8][9][10]. The main drawback, however, is a lack of specificity; other disease processes produce similar MRI findings [10].…”

“…Thus, a very elevated WBC count in the cerebrospinal fluid warrants a more extensive search for an alternate diagnosis. In addition, there is typically an elevation of CSF immunoglobulin (Ig) levels relative to other protein components, suggesting intrathecal synthesis of Ig [2][3][4][5]. A recent consensus statement indicated that qualitative comparison of the IgG fraction for the presence of CSF-specific oligoclonal bands (OCBs) could help diagnose MS [11].…”