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Multiple Sclerosis
  • Multiple Sclerosis is an inflammatory disease in which fatty myelin sheaths around axons of brain and spinal cord are damaged. Usually occurs in young adults, more in women. Variable prevalence in different geographical areas(Range : 2-150 per 100,000).More in adults.
  • Common symptoms include blurring of vision, double vision, decreased or abnormal sensation in body parts, muscle weakness, difficulty in speaking, difficulty in swallowing, imbalance while walking, urinary and sexual dysfunction.
  • Exact cause is not known. It is considered to be combination of genetic, environmental and infectious agents.
  • Diagnosis is by detailed clinical examination by a neurologist, supported by lab investigations like MRI, blood tests and electrophysiological tests.
  • Most common variety is relapsing and remitting type in which symptoms improve or recurs in same or other area after sometime.
  • Treatment has to be individualized for each patient depending on severity of illness. Acute attacks are treated with high dose injections of methyl prednisolone. To prevent further attacks, patients requires prophylactic treatment . Commonly used agents are Interferons, Glatrimate, Mitoxantran and Monoclonalantibodies(Natalizumab).
  • Treatment requires close coordination between doctors and physiotherapy / rehabilitation team .
  • Prognosis of person with multiple sclerosis depends on type of disease, severity, sex, age at onset,30 years being the mean time to death from disease onset.

Peripheral Neuropathy

  • Peripheral neuropathy is damage to nerves of peripheral nervous system. It can be caused by primary disease of nerves, trauma or side effects of systemic illness and drugs.
  • Types include :
    • polyneuropathy(involvement of many nerves in definite pattern).
    • Mononeuropathy (single nerve involvement).
    • Mononeuritis Multiplex (scattered involvement).
    • Cutaneous neuropathy.
  • Common symptoms are numbness, tingling, pain, burning, crawling, pins and needle, difficulty in walking, tremors, weakness of limbs. Patients also have loss of sensation. In advance case it causes urinary and sexual dysfunction.
  • Common causes are diabetes mellitus, renal failure, hypothyroidism, alcohol, vitamin B12 deficiency, drugs(cancer treatment, isoniazide, phenytoin), heavy metals(frequently used in alternative medicines), local nerve injury , infection and genetic.
  • Diagnosis is made on basis of symptoms, clinical examination, history, supported by laboratory investigations- mainly nerve conduction studies( ENMG).
  • Treatment can be classified in two categories :
    • To identify the cause and treat it , like stop alcohol intake, change drugs if possible, correct vitamin deficiency, etc.
    • Symptomatic : Many cases of peripheral neuropathy are idiopathic (without identifiable etiology) or primary disease or cause cannot be treated. In these cases only symptomatic treatment is given to relieve symptoms.
  • Medications used are tricyclic antidepressants, gapapentin, pregabalin, carbamazepine. Transcutaneous Electrical Nerve Stimulation (TENS) is also useful in selected cases.

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