Clinical Introduction to Multiple Sclerosis

Question 1

How many MS patients are there globally?

How many in the
Netherlands per 1000 citizens?

Women : Men ratio?

Typical age of diagnosis?

Answer 1

2-3 million people in the world have MS.

1-2 per 1000 citizens have MS in the Netherlands

Women : Men ratio is 2-3 : 1

Typical age of diagnosis is 20-40 years

Question 2

Where is MS mostly diagnosed?

Answer 2

In North-America and West Europe

Question 3

In what Nervous System is MS located?

Answer 3

In the Central Nervous System (CNS)

Question 4

What is the pathology of MS?

Answer 4

Demyelination (& inflammation) in the neurons in the Central Nervous System.

Question 5

What can be seen on a brain MRI scan in MS patients?

Answer 5

1. Demyelinating lesions (white spots) in the ‘white matter’.
2. Loss of brain tissue.
3. Increase in cerebrospinal fluid in the brain.

Question 6

Genetically speaking, which family members could have increased risk of aqcuiring MS?

Answer 6

Monozygotic twins, followed with:

Sibling with two affected parents, Sibling with one affected parent and a Dizygotic twin.

Question 7

What are possible environmental factors that can cause MS?

Answer 7

• Vitamin D deficiency
• Smoking
• Early obesity
• Been infected before with Epstein-Barr Virus (Pfeiffer disease)

Question 8

What are the symptoms of MS?

Answer 8

• Optic neuritis (decreased vision, disturbance of color vision, pain behind eyes).
• Eye movement abnormalities
• Lhermitte’s symptom (electrical sensation that runs from the back into the limbs).
• Motor dysfunction (decreased ability to walk etc.)
• Bladder (erectile/sexual) dysfunction
• Psychological dysfunction, such as cognitive impairment
• Fatigue

Question 9

What are the 3 types of disease progression in MS patients?

Answer 9

1. Primary Progressive MS (PPMS), steady increase in degeneration without ‘attacks’.
2. Secondary Progressive MS (SPMS), MS with relapsing periods without actual remission.
3. Relapsing-Remitting MS (RRMS), unpredictable ‘attacks’ of MS, followed by periods of remission.

Question 10

How is MS diagnosed (when looking at dissemination in space and time)?

Answer 10

• More than 1 relapse period
• Increasing number of demyelinating lesions (on follow up MRI), and increase in contrast of the lesions
• Decrease in brain tissue
• Increase in cerebrospinal fluid (shown on MRI) and presence of oligoclonal bands in the cerebrospinal fluid.
• Increase in IgG levels