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MS is the most common cause of progressive neurological disability in the 20–50 yr age group. Early diagnosis is difficult. For diagnostic criteria, refer to www.nice.org.uk.
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Commoner clinical features
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Transient motor and sensory disturbances
Upper motor neurone signs
Common initial symptoms include:
– visual disturbances of optic neuritis; unilateral visual loss, painful movements
– diplopia (brain-stem lesion)
– weakness in one or both legs (paraparesis) or hemiparesis
– ascending sensory impairment in the lower limbs and trunk
– vertigo (brain-stem lesion)
Subsequent remissions and exacerbations
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Lesions separated in time and place. MRI the best investigation: sensitivity 90%.
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Early referral to a neurologist
Education and support: CBT or mindfulness-based therapy
No specific drug for MS
Corticosteroids, e.g. methylprednisolone, reduce severity of acute attack and are used for severe relapses; prednisolone for moderate relapses in OP setting
Beta-interferon, glatiramer and monoclonal antibodies, e.g. natalizumab, may reduce number of relapses (under evaluation but seem effective)
Plasma exchange may be used