Multiple sclerosis

Multiple sclerosis
Other namesMultiple cerebral sclerosis, multiple cerebro-spinal sclerosis, disseminated sclerosis, encephalomyelitis disseminata
CD68-stained tissue shows several macrophages in the area of a demyelinated lesion caused by MS.
SpecialtyNeurology
SymptomsInvolving autonomic, visual, motor, and sensory systems, almost any central or peripheral neurological symptom.[1]
Usual onsetAge 20–50[2]
DurationLong term[3]
CausesUnknown[4]
Diagnostic methodBased on symptoms and medical tests[5]
Treatment
  • Disease-modifying therapies[6]
  • Physiotherapy[7]
  • Occupational therapy[7]
Frequency0.032% (world)

Multiple sclerosis (MS) is an autoimmune disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.[3] Being a demyelinating disease, MS disrupts the ability of parts of the nervous system to transmit signals, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems.[1][8][9] Symptoms include double vision, vision loss, eye pain, muscle weakness, and loss of sensation or coordination.[3][10][11] MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms).[12][13] In relapsing forms of MS, between attacks, symptoms may disappear completely, although some permanent neurological problems often remain, especially as the disease advances.[13] In progressive forms of MS, bodily function slowly deteriorates once symptoms manifest and will steadily worsen if left untreated.[14]

While its cause is unclear, the underlying mechanism is thought to be either destruction by the immune system or failure of the myelin-producing cells.[4] Proposed causes for this include immune dysregulation, genetics, and environmental factors, such as viral infections.[15][16][8][17] MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests.[5]

No cure for multiple sclerosis is known.[18] Current treatments are aimed at mitigating inflammation and resulting symptoms from acute flares and prevention of further attacks with disease-modifying medications.[8][19] Physical therapy[7] and occupational therapy,[20] along with patient-centered symptom management, can help with people's ability to function. The long-term outcome is difficult to predict; better outcomes are more often seen in women, those who develop the disease early in life, those with a relapsing course, and those who initially experienced few attacks.[21]

Multiple sclerosis is the most common immune-mediated disorder affecting the central nervous system.[22] Nearly one million people in the United States had MS in 2022,[23] and in 2020, about 2.8 million people were affected globally, with rates varying widely in different regions and among different populations.[24] The disease usually begins between the ages of 20 and 50 and is twice as common in women as in men.[2] MS was first described in 1868 by French neurologist Jean-Martin Charcot.[25]

The name "multiple sclerosis" is short for multiple cerebro-spinal sclerosis, which refers to the numerous glial scars (or sclerae – essentially plaques or lesions) that develop on the white matter of the brain and spinal cord.[25]

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  2. ^ a b Milo R, Kahana E (March 2010). "Multiple sclerosis: geoepidemiology, genetics and the environment". Autoimmunity Reviews. 9 (5): A387-94. doi:10.1016/j.autrev.2009.11.010. PMID 19932200.
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  7. ^ a b c Alphonsus KB, Su Y, D'Arcy C (April 2019). "The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis". Complementary Therapies in Medicine. 43: 188–195. doi:10.1016/j.ctim.2019.02.010. PMID 30935529. S2CID 86669723.
  8. ^ a b c Compston A, Coles A (April 2002). "Multiple sclerosis". Lancet. 359 (9313): 1221–1231. doi:10.1016/S0140-6736(02)08220-X. PMID 11955556. S2CID 14207583.
  9. ^ Murray ED, Buttner EA, Price BH (2012). "Depression and Psychosis in Neurological Practice". In Daroff R, Fenichel G, Jankovic J, Mazziotta J (eds.). Bradley's neurology in clinical practice (6th ed.). Philadelphia, PA: Elsevier/Saunders. ISBN 978-1-4377-0434-1.
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  11. ^ Mazumder R, Murchison C, Bourdette D, Cameron M (25 September 2014). "Falls in people with multiple sclerosis compared with falls in healthy controls". PLOS ONE. 9 (9): e107620. Bibcode:2014PLoSO...9j7620M. doi:10.1371/journal.pone.0107620. PMC 4177842. PMID 25254633.
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  13. ^ a b [medical citation needed]Lublin FD, Reingold SC (April 1996). "Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis". Neurology. 46 (4): 907–911. doi:10.1212/WNL.46.4.907. PMID 8780061. S2CID 40213123.
  14. ^ Loma I, Heyman R (September 2011). "Multiple sclerosis: pathogenesis and treatment". Current Neuropharmacology. 9 (3): 409–416. doi:10.2174/157015911796557911. PMC 3151595. PMID 22379455.
  15. ^ Ward M, Goldman MD (August 2022). "Epidemiology and Pathophysiology of Multiple Sclerosis". Continuum. 28 (4): 988–1005. doi:10.1212/CON.0000000000001136. PMID 35938654. S2CID 251375096.
  16. ^ Aloisi F, Cross AH (October 2022). "MINI-review of Epstein-Barr virus involvement in multiple sclerosis etiology and pathogenesis". Journal of Neuroimmunology. 371: 577935. doi:10.1016/j.jneuroim.2022.577935. PMID 35931008. S2CID 251152784.
  17. ^ Ascherio A, Munger KL (April 2007). "Environmental risk factors for multiple sclerosis. Part I: the role of infection". Annals of Neurology. 61 (4): 288–299. doi:10.1002/ana.21117. PMID 17444504. S2CID 7682774.
  18. ^ "NINDS Multiple Sclerosis Information Page". National Institute of Neurological Disorders and Stroke. 19 November 2015. Archived from the original on 13 February 2016. Retrieved 6 March 2016.
  19. ^ McGinley MP, Goldschmidt CH, Rae-Grant AD (February 2021). "Diagnosis and Treatment of Multiple Sclerosis: A Review". JAMA. 325 (8): 765–779. doi:10.1001/jama.2020.26858. PMID 33620411. S2CID 232019589.
  20. ^ Quinn É, Hynes SM (July 2021). "Occupational therapy interventions for multiple sclerosis: A scoping review". Scandinavian Journal of Occupational Therapy. 28 (5): 399–414. doi:10.1080/11038128.2020.1786160. hdl:10379/16066. PMID 32643486. S2CID 220436640.
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    * Charcot J (1868). "Histologie de la sclerose en plaques". Gazette des Hopitaux, Paris. 41: 554–5.