Multiple sclerosis

Multiple sclerosis (MS) is a chronic degenerative disorder of the brain and spinal cord. The exact cause is unknown. It is proposed that patients who develop multiple sclerosis (MS) may have a genetic susceptibility. An autoimmune response to neural tissue is triggered by an unknown environmental factor, perhaps a virus. This immune reaction causes inflammation and destruction of the myelin (protective sheath) of the nerve fibers. The loss of myelin is referred to as demyelination. The end result is impairment of neurological signal transmission between different parts of he brain and the body.

Multiple sclerosis and demyelinization

Multiple sclerosis and demyelinization

According to, 2.3 million people suffered from MS worldwide in 2013. The incidence is 2,5 per 100 000. It is more common in female patients and usually presents between 20 and 50 years of age.

MS is potentially disabling. The severity and progression, however, are unpredictable. Some patient’s condition will rapidly progress whilst others may go into remission periods with few symptoms.

A patient with MS may exhibit any neurological symptom or sign. Common functional impairments include sensory, autonomic, visual and motor nerve disorders. No wonder that balance problems are so common. Some patients even experience difficulty in walking. Patients with MS may also have memory loss, mental retardation and psychiatric problems.

Dizziness and vertigo are common in patients with MS. Lightheadedness and imbalance may occur in up to 50% of patients. Acute (sudden onset) vertigo may be the presenting symptom in 15% of patients with MS. Some patients may also complain of positional vertigo. The most common clinical findings in patients with dizziness and disequilibrium are ataxia, nystagmus and oculomotor disturbances. In addition to this, there are generally specific eye and oculomotor findings such as an internuclear ophthalmoplegia (INO), impairment of smooth pursuit and abnormal saccades.

The diagnosis of MS is based on the clinical presentation, magnetic resonance imaging (MRI), cerebrospinal fluid analysis and visual and sensory evoked potential test.

There is no cure for MS. Management includes medication to improve function after an attack and prevent further attacks. Physical therapy and occupational devices may improve patient’s ability to function.