Multiple Sclerosis Mnemonic

Multiple sclerosis is an autoimmune disease of white matter that occurs due to interaction of genetic factors with unknown environmental factors. It is characterized by the pathological triad of inflammation, demyelination and gliosis. It is diagnosed using McDonald’s criteria. My mnemonic for clinical features and treatment of multiple sclerosis is: MULTIPLE SCLEROSIS.

multiple sclerosis types
Relapsing remitting type is the commonest – 85% cases.

Motor: UMNL

Mental function (Higher mental function): Mild cognitive changes, apathy, inattention, depression, euphoria

Uhthoff’s phenomenon: worsening of symptoms on exposure to heat (hot water bath) or exercise, and occurs due to conduction block

Lhermitte’s sign

Trigeminal neuralgia

Internuclear ophthalmoplegia and optic neuritis

Incontinence (bowel and bladder involvement)

Pulfrich effect: may occur when conduction latencies between the eyes are unequal, resulting in a sense of disorientation in moving traffic

Lesions disseminated in time and space: Dissemination in time indicates involvement of more than one area of CNS dysfunction. All events occurring within 30 days of an event are considered to be part of a single event. Dissemination of space indicates involvement of more than one area of the CNS.

Exacerbations and remissions

Sensory: Posterior column involvement

Cerebellar signs

Language: Dysarthria

Evoked potential: prolongation

Ruled out if: LMN lesions, peripheral nerve involvement, prominent cortical signs, early dementia and extrapyramidal signs

Oligoclonal bands in CSF electrophoresis

Steroids for acute exacerbation

Immunotherapy (Disease modifying drugs): ABC MN – Avonex (IFN β1a), Betaseron (IFN β1b), Copaxone (Glatiramer), Mitoxantrone and Natalizumab

Symptomatic management with baclofen (for spasticity) and anticholinergics (for spastic bladder)

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