Multiple sclerosis

What is MS?

Multiple sclerosis is a chronic, immune-mediated, demyelinating inflammatory condition of the central nervous system, which affects the brain, optic nerves and spinal cord, and leads to progressive severe disability.

What are the two types of MS?

1. Relapsing-remitting multiple sclerosis is the most common pattern of the disease.

2. Progressive multiple sclerosis

What is the meaning of active MS?

Disease activity is defined as active if at least two clinically significant relapses occur within the last 2 years.

This is despite treatment with interferon beta.

What is the aim of MS treatment?

There is no cure.

The overall aims is to modify the course of the disease and manage symptoms, in order to improve quality of life.

Treatment is aimed at reducing the frequency and duration of relapses and at preventing or slowing disability.

How are relapses treated?

Methylprednisolone

How is fatigue treated? 3 options

• Amantadine

• SSRI

• Modafinil

Vitamin B₁₂ injections are not recommended as a treatment for fatigue in patients with multiple sclerosis

How is spasticity (tight or stiff muscles) treated?

First line: baclofen

Second line: gabapentin

4-week trial of cannabis extract can be offered as adjunctive treatment for moderate to severe spasticity in multiple sclerosis if other pharmacological treatments are not effective (specialist only)

How should baclofen be dosed and why?

INCREASE DOSE SLOWLY to avoid major side effects e.g. sedation + hypotonia.

How is oscillopsia (objects appear to vibrate) treated?

First line: gabapentin

Second line: memantine

How is emotional lability (rapid and unpredictable mood changes) treated?

Amitriptyline