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Multiple Sclerosis. Walter Royal, III, MD Associate Professor, Department of Neurology University of Maryland School of Medicine Director, Maryland Center for Multiple Sclerosis Treatment and Research. What is Multiple Sclerosis?.

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Multiple sclerosis l.jpg

Multiple Sclerosis

Walter Royal, III, MD

Associate Professor, Department of Neurology

University of Maryland School of Medicine

Director, Maryland Center for Multiple Sclerosis Treatment and Research

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What is Multiple Sclerosis?

  • Multiple Sclerosis (MS) is an chronic inflammatory demyelinating disease of the brain and spinal cord.

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Areas affected by MS


Spinal cord

Optic nerves

The Human Nervous System


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MS is an Immune-Mediated Disease

BBB=blood-brain barrier; APC=antigen-presenting cell.

Adapted from Miller et al. Continuum: Multiple Sclerosis (Part A). 1999;5:7.

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How Common is MS and Who Gets It?

  • 8,000 – 10,000 new cases are diagnosed annually

  • Affects nearly 500,000 individuals in the U.S.

  • Occurs most frequently between ages 25 - 35

  • Female: male ratio = 2:1

  • More frequent in populations native to areas further away from the equator

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What Causes MS?

  • Genetics

  • Environmental factors

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Monozygotic (identical) twins

Dizygotic (non-identical) twins

Child of parent with MS

Sibling of person with MS

25 – 30%

3 – 4.5%



Family Studies

Up to 19% of patients have an affected relative

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Groups for Which MS Genetic Traits Have Been Identified:

  • Japanese

  • African American

  • Mexican

  • Arabian

  • Sardinian (Italy)

  • Swedish

  • Norwegian

  • French Canadian

  • Multi-ethnic Caucasian

  • Finnish

  • Etc.

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Not Everyone with a Genetic Risk Will Develop MS – Why?

  • Risk is modified by Environmental factors

    • Sunlight

    • Diet (e.g., vitamin D)

    • Other lifetime experiences (infections?)

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Multiple Sclerosis Clinical Subtypes

Lublin FD et al. Neurology. 1996;46:907-911.

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How Is MS Diagnosed?

  • At least two episodes of symptoms

    • Occur at different points in time

    • Result from involvement of different areas of the central nervous system

  • Absence of other treatable causes for the symptoms

  • Results of neurological testing

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Examples of MS Onset

  • Case 1: 26 year old woman

    • Decreased vision in the right eye in 9/05

    • Left leg numbness in 1/06

    • Right face numbness, right arm and leg weakness in 4/06

    • Left leg weakness in 8/06

  • Case 2: 45 year old man

    • Left arm weakness in 2/93

    • Numbness below the waist in 4/07

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Other Potential Causes ofMS-like Symptoms

  • Lyme disease

  • Lupus

  • Migraine

  • Non-recurrent inflammatory process

  • Encephalitis

  • Stroke

  • Tumor of the brain or spinal cord

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How Is MS Diagnosed?

  • Neurological examination

  • Magnetic resonance imaging (MRI) Scan

  • Blood tests

  • Lumbar Puncture (spinal tap): occasionally performed

  • Other testing: infrequently performed

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Assessment of the Appearance of

MS Lesions Over time

Time lapse = 1 year

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Images acquired over the course of 7 years from a single person with untreated MS

Brain Atrophy (Shrinkage) in Untreated MS

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Brain Atrophy (Shrinkage) person with untreated MS in Untreated MS

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How is MS Treated and Managed? person with untreated MS

  • Drug therapy

    • Treat new attacks (exacerbations)

    • Prevent the occurrence of future attacks

    • Slow or prevent disease progression

    • Treat the chronic symptoms of the disease

  • Physical therapy

  • Psychosocial support

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Treatment of New MS Exacerbations person with untreated MS

  • Drug therapy

    • Corticosteroids

    • Intravenous immunoglobulin

    • Plasma exchange

  • Physical therapy

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Prevention of Future Attacks and Disease Progression person with untreated MS

  • Immune modulating drugs

    • Beta-Interferon

    • Glatiramer acetate

    • Humanized monoclonal antibodies

  • Immunosuppressant drugs

    • Anti-cancer agents

  • Combination therapies

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Symptom Management – Examples person with untreated MS

  • Pain control

  • Management of impaired bladder and bowel function

  • Anti-spasmodic drugs

  • Treatment of fatigue

  • Splinting for contractures

  • Counseling

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MS Therapies: What Lies Ahead? person with untreated MS

  • Neural protection

  • Regenerative therapies

  • Cell replacement (stem cells)

  • Dietary approaches (vitamin D)

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Multiple Sclerosis Research at the University of Maryland person with untreated MS

  • Drug therapies

    • Injectable drugs with increased efficacy

    • New oral agents

  • Cell replacement therapies

    • Stem cell research

  • MS “vaccine”

  • Novel rehabilitation techniques

    • Robotics

  • Dietary approaches

    • Studies of the role of vitamin D in MS

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Summary person with untreated MS

  • MS is a common inflammatory disease of the CNS that affects females more frequently than males.

  • The cause of MS appears to be a combination of genetic and environmental factors.

  • The symptoms of MS can be quite variable.

  • MRI is a sensitive test for making the diagnosis of MS.

  • Treatments are available for reducing the number of MS attacks and for slowing MS disease progression.