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Suspected cases of multiple sclerosis (MS) are usually young adults attending the neurology outpatient clinic. The onset of symptoms is rare before puberty or after the age of 60 years; however, being a relatively common neurological disease (1:800 in UK), both situations may be familiar to practising neurologists. MS will usually present with either a history of acute relapse(s) or with progressive neurological impairment
Key points
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MS is a clinical diagnosis
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Usefulness of investigations can only be extrapolated from a research study to the clinical setting if the clinical picture is the same as in the study
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Brain MRI is abnormal in the majority of patients with MS
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Patients with a monophasic presentation can be diagnosed with MS using interval gadolinium enhancing or T2 weighted longitudinal MRI
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VEPs, OCBs, and spinal cord MRI are useful if the MRI brain is negative and in patients with a progressive presentation
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An abnormal MRI following a clinically isolated episode carries a > 80% risk of clinically definite MS after 10 years
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A normal MRI following a clinically isolated episode carries a 11% risk of clinically definite MS over 10 years
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A follow up counselling session to discuss MS is useful for patient and relatives
RELAPSING REMITTING DISEASE
The most common presentation of MS is following a relapse. The peak age of the first episode is in the third decade; however, patients often present to the neurologist later with their second or third relapse or less commonly in the secondary progressive phase of illness. This form of MS is twice as common in women as in men.
The most common scenario is a patient of 20–40 years old referred fairly urgently to the outpatient clinic with a subacute onset of neurological disturbance, most commonly sensory symptoms, often resolving by the time they are seen. Because sensory symptoms …