Multiple sclerosis
A chronic immune-mediated disease of the central nervous system causing neurological lesions and symptoms that are disseminated in space and time; diagnosis is specialist-led, relapses and progression must be distinguished, and disease-modifying therapy is selected according to disease activity.
Definition
Multiple sclerosis is a chronic immune-mediated disease of the central nervous system that causes neurological dysfunction through inflammatory demyelination and axonal injury. Clinical courses include relapsing disease and progressive disease, with or without ongoing inflammatory activity.
First principles
A focal CNS lesion produces a pathway-specific deficit
Inflammation and demyelination damage central nervous system axons and their myelin. The symptom pattern depends on the tract involved: optic nerve disease causes painful monocular visual loss, spinal cord disease causes weakness, sensory disturbance or bladder dysfunction, and brainstem or cerebellar disease causes diplopia, internuclear ophthalmoplegia, ataxia or dysarthria.
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