4: Multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) and a common cause of disability in young adults; it is most likely an autoimmune disease. Typically, MS initially follows a relapsing-remitting course, but most pati ents eventually develop secondary progressive MS, where there is progressiv e deterioration without relapses or remissions; in some patients, MS has a primary progressive course. The diagnosis of MS requires evidence of CNS lesions disseminated in time a nd place, as well as the exclusion of other likely causes of these lesions; the clinical history, neurological examination and investigations, such as magnetic resonance imaging of the brain and spinal cord, all have key role s in the diagnosis. Education and counselling of the patient and family members are essential f or good patient management. Moderate to severe attacks of MS are best treated with intravenous infusion s of high-dose methylprednisolone. Interferon beta reduces the frequency of attacks and the progression of dis ability in relapsing-remitting MS. Symptomatic therapy is important in the management of spasticity, pain, uri nary problems and the other symptoms or complications of MS.