title: Multiple sclerosis- diagnosis, management and prognosis.
abstract: BACKGROUND
  Multiple sclerosis is the most common chronic disabling disease of the central nervous system in young adults.
  
  
  OBJECTIVE
  This article summarises the diagnosis, management and prognosis of multiple sclerosis.
  
  
  CONCLUSIONS
  Multiple sclerosis usually starts with an acute episode of neurological disturbance, termed a 'clinically isolated syndrome', followed by an illness phase punctuated by relapses and remissions which may transition after 10 years to a phase of progressive accumulation of disability without relapses. Fifteen to 20% of patients will have a progressive course from the onset. There is significant interpatient variability in prognosis. The main diagnostic criteria are clinical, supported by investigations including magnetic resonance imaging and lumbar puncture and evoked potentials. First line disease modifying agents for relapsing remitting multiple sclerosis include interferon-ß and glatiramer. First line treatment for relapses is usually intravenous methylprednisolone for 3 days. Troublesome symptoms may include spasticity, parasthesias, tremor, erectile dysfunction, depression and anxiety, fatigue and pain. After excluding differential diagnoses, symptomatic management includes pharmacological agents, allied health consultation and continence strategies. Although pregnancy reduces disease activity, there is a higher risk of relapse in the postpartum period.
authors.affiliation: Department of Neurology, Austin Hospital, Melbourne, Victoria, Australia. bktsang@optusnet.com.au
authors.forename: Benjamin K-T
authors.initials: BK
authors.lastname: Tsang
authors.forename: Richard
authors.initials: R
authors.lastname: Macdonell
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001315:Australia / Q000453:epidemiology; D003937:Diagnosis, Differential; D018450:Disease Progression; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage*; D016899:Interferon-beta / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D016899:Interferon-beta; D008942:Mitoxantrone