Multiple sclerosis: fighting the invisible
- 1. MULTIPLE SCLEROSIS Fighting the invisible DR SUDHIR KUMAR MD DM Consultant Neurologist Apollo Hospitals, Hyderabad
- 2. Outline of my Presentation • What is multiple sclerosis? • How common is it? • Common signs and symptoms • How is it diagnosed? • How is it treated? • MS and pregnancy • Long-term outcome in patients with MS
- 3. What is Multiple Sclerosis? • MS is a demyelinating disorder of central nervous system affecting brain, spinal cord and optic nerves.
- 4. How Common is MS? • About 2.5 million MS patients worldwide • Prevalence varies- more common in Europe and North America; less in India • 3 times more common in women than men • Most common between 20-40 years, can occur in children too.
- 5. Signs & Symptoms • Visual loss • Tingling, numbness, weakness of one half of body or both legs/hands • Imbalance • Bladder symptoms
- 6. Diagnosis • MRI of brain and spinal cord • Lumbar puncture • Exclusion of other diseases that can cause similar symptoms
- 7. Treatment • Acute stage: 5 day course of methylprednisolone injections • Prevention of relapses- disease modifying agents (interferons, dimethylfumarate, teriflunomide, natalizumab, etc)
- 8. MS in Pregnancy (1) • Better to start DMD and then plan pregnancy • MS usually does not adversely affect fertility or pregnancy • MS relapses are lesser in 2nd and 3rd trimesters of pregnancy, however, it increases after delivery • Among DMDs, interferons and glatiramer are safe. (Avoid teriflunomide in men with MS)
- 9. MS and Pregnancy • Steroids are safe in pregnancy. • There is no significant increased risk of MS in babies born to mothers with MS • Breastfeeding is safe in women on DMD • Pregnancy and childbirth reduce the risk of severe disability later in life in women with MS
- 10. Long-term Outcome • 85% of MS patients do well • MS patients who use DMDs are less disabled (than who don’t use) • Severe disability occurs in 10-15%. • Longevity and survival have been increasing over time, with average life span about 70 years (7-14 years lesser than general population)