Multiple Sclerosis (MS)

History

• Painful eye movements, often with blurred/monocular vision loss (optic neuritis)

• Lower limb weakness/paraesthesia

• Multiple neurological symptoms separated in time and space

• Uhthoff’s phenomenon: Worsening symptoms with heat or exertion

Examination

• UMN signs: Weakness, sensory loss, hyperreflexia

• LMN signs: Rare, but some lesions might mimic peripheral presentations

• Lhermitte’s sign: Electric shock sensation down the spine/limbs on neck flexion

• Optic nerve involvement: Optic disc swelling or pallor, reduced visual acuity, possible visual field deficits

Investigations

• MRI brain ± C-spine: Demonstrates ≥2 distinct lesions disseminated in time and space

• CSF: Elevated IgG oligoclonal bands (supportive if MRI is inconclusive)

• Visual Evoked Potentials: May show delayed conduction if optic nerve involvement is suspected

Treatment

• Education: Explain relapsing-remitting nature in many cases

• Comorbidity Management: Address depression, anxiety, possible spasticity or pain syndromes

• Relapses: High-dose corticosteroids (e.g. prednisolone or IV methylprednisolone)

• Neurologist Referral: Key for disease-modifying therapies (e.g. interferon beta, glatiramer acetate), also newer biologics (natalizumab, fingolimod)

• Rehabilitation: Physiotherapy (strength, balance), OT (daily aids), psychological support (CBT), social work (community resources)

• Lifestyle: Smoking cessation, ensure adequate vitamin D