Multiple sclerosis natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Multiple sclerosis usually starts between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as [[optic neuritis]], [[diplopia]], [[sensory]] or motor loss, [[vertigo]], and [[Balance disorder|balance]] problems. It may be classified into four groups according to [[clinical]] course of the [[disease]] including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing.<ref name="pmid8780061" /> [[Complications]] that can develop as a result of mutiple sclerosis are: medication complication, [[Fatigue]]<ref name="pmid16900749" />, [[mood]] problems<ref name="pmid8618657" />, [[Spasticity]]<ref name="pmid17868019" />, [[Bowel]] and [[bladder]] dysfunction<ref name="pmid10631634" />, [[Cognitive impairment]]<ref name="pmid12640060" /><ref name="pmid15774439" /><ref name="pmid2027484" /><ref name="pmid15277630" />, Heat sensitivity.<ref name="pmid7550931" />, [[Incoordination]]<ref name="pmid25573524" />, [[Pain]]<ref name="pmid26087108" /><ref name="pmid23318126" />, [[Sexual dysfunction]]<ref name="pmid26003254" /><ref name="pmid10618700" />, Sleep disorders<ref name="pmid17942519" /><ref name="pmid8787103" /><ref name="pmid23078359" />, [[vertigo]]<ref name="pmid11094117" />, [[visual loss]]<ref name="pmid16554529" />. there are some factors associated with a particularly poor [[prognosis]] among [[patients]] with multiple sclerosis such as: Relapsing versus progressive disease<ref name="pmid8017890" /><ref name="pmid11078767" /><ref name="pmid16434648" />, early symptoms<ref name="pmid17172607" />, Demographics<ref name="pmid15596747" />, Sex<ref name="pmid8017890" />, Smoking<ref name="pmid23628463" />
Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with [[symptoms]] such as [[optic neuritis]], [[diplopia]], [[Sensory loss|sensory]] or [[Muscle weakness|motor loss]], [[vertigo]] and [[Balance disorder|balance]] problems. It may be classified into four groups according to [[clinical]] course of the [[disease]] including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. [[Complications]] that can develop as a result of multiple sclerosis are: [[medication]] [[complication]], [[Fatigue]], [[mood]] problems, [[Spasticity]], [[Bowel]] and [[bladder]] dysfunction, [[Cognitive impairment]], Heat sensitivity., [[Incoordination]], [[Pain]], [[Sexual dysfunction]], [[Sleep disorder|Sleep disorders]], [[vertigo]], [[visual loss]]. there are some factors associated with a particularly poor [[prognosis]] among [[patients]] with multiple sclerosis such as: Relapsing versus progressive disease, early symptoms, Demographics, Sex, [[Smoking]].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


=== Natural History ===
=== Natural History ===
* Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as [[optic neuritis]], [[diplopia]], [[sensory]] or motor loss, [[vertigo]], and [[Balance disorder|balance]] problems. In young adult eye and [[sensory]] problems are prominent while in older patients we see motor problems more often.<ref name="pmid2917275">{{cite journal |vauthors=Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC |title=The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability |journal=Brain |volume=112 ( Pt 1) |issue= |pages=133–46 |date=February 1989 |pmid=2917275 |doi= |url=}}</ref>  
* Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with [[symptoms]] such as [[optic neuritis]], [[diplopia]], [[Sensory loss|sensory]] or [[Muscle weakness|motor loss]], [[vertigo]], and [[Balance disorder|balance]] problems. In young adult eye and [[sensory]] problems are prominent while in older patients we see [[Motor skill|motor]] problems more often.<ref name="pmid2917275">{{cite journal |vauthors=Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC |title=The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability |journal=Brain |volume=112 ( Pt 1) |issue= |pages=133–46 |date=February 1989 |pmid=2917275 |doi= |url=}}</ref>  
* The natural history of the disease is either relapsing or progressive. Relapsing-remitting multiple sclerosis is defined by acute attacks of [[neurological]] [[dysfunction]] followed by full or partial [[recovery]]. Patient clinical [[symptoms]] are stable between the attacks. It can switch to secondary progressive disease when the [[neurological]] [[symptoms]] progressively worsen between the attacks. There is also primary progressive type, which is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks and [[remission]]<nowiki/>s. proressive relapsing type is a mixture of relapsing and progression and is defined by progression of [[disease]] from the beginning with acute attack episodes.<ref name="pmid8780061">{{cite journal |vauthors=Lublin FD, Reingold SC |title=Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis |journal=Neurology |volume=46 |issue=4 |pages=907–11 |date=April 1996 |pmid=8780061 |doi= |url=}}</ref>
* The [[Natural history of disease|natural history]] of the disease is either relapsing or progressive.  
* The most common [[symptoms]] in all of the [[MS]] patients are [[fatigue]]<ref name="pmid25700869">{{cite journal |vauthors=Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P |title=Sleep disorders in patients with multiple sclerosis |journal=J Clin Sleep Med |volume=11 |issue=5 |pages=553–7 |date=April 2015 |pmid=25700869 |pmc=4410929 |doi=10.5664/jcsm.4702 |url=}}</ref>, [[Mood disorders|mood problems]]<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref>, [[spasticity]]<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>, [[bowel]] and [[bladder]] dysfunction<ref name="pmid12515563">{{cite journal |vauthors=DasGupta R, Fowler CJ |title=Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies |journal=Drugs |volume=63 |issue=2 |pages=153–66 |date=2003 |pmid=12515563 |doi= |url=}}</ref>, [[cognitive impairment]]<ref name="pmid12640060">{{cite journal |vauthors=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=74 |issue=4 |pages=443–6 |date=April 2003 |pmid=12640060 |pmc=1738365 |doi= |url=}}</ref>, eye movement abnormalities<ref name="pmid15664543">{{cite journal |vauthors=Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S |title=The neuro-ophthalmology of multiple sclerosis |journal=Lancet Neurol |volume=4 |issue=2 |pages=111–21 |date=February 2005 |pmid=15664543 |doi=10.1016/S1474-4422(05)00992-0 |url=}}</ref>, heat sensitivity<ref name="pmid7550931">{{cite journal |vauthors=Selhorst JB, Saul RF |title=Uhthoff and his symptom |journal=J Neuroophthalmol |volume=15 |issue=2 |pages=63–9 |date=June 1995 |pmid=7550931 |doi= |url=}}</ref>, [[incoordination]]<ref name="pmid25573524">{{cite journal |vauthors=Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR |title=Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey |journal=BMJ Open |volume=5 |issue=1 |pages=e006714 |date=January 2015 |pmid=25573524 |pmc=4289717 |doi=10.1136/bmjopen-2014-006714 |url=}}</ref> , [[pain]]<ref name="pmid26087108">{{cite journal |vauthors=Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T |title=The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey |journal=Pain Med |volume=16 |issue=8 |pages=1597–602 |date=August 2015 |pmid=26087108 |doi=10.1111/pme.12731 |url=}}</ref>, [[sexual dysfunction]]<ref name="pmid26003254">{{cite journal |vauthors=Lew-Starowicz M, Gianotten WL |title=Sexual dysfunction in patients with multiple sclerosis |journal=Handb Clin Neurol |volume=130 |issue= |pages=357–70 |date=2015 |pmid=26003254 |doi=10.1016/B978-0-444-63247-0.00020-1 |url=}}</ref>, [[Sleep disorder|sleep disorders]]<ref name="pmid17942519">{{cite journal |vauthors=Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M |title=Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage |journal=Mult. Scler. |volume=14 |issue=1 |pages=86–93 |date=January 2008 |pmid=17942519 |doi=10.1177/1352458507080734 |url=}}</ref>, [[vertigo]]<ref name="pmid11094117">{{cite journal |vauthors=Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC |title=Vertigo in MS: utility of positional and particle repositioning maneuvers |journal=Neurology |volume=55 |issue=10 |pages=1566–9 |date=November 2000 |pmid=11094117 |doi= |url=}}</ref> and [[Vision loss|visual loss]]<ref name="pmid16554529">{{cite journal |vauthors=Balcer LJ |title=Clinical practice. Optic neuritis |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1273–80 |date=March 2006 |pmid=16554529 |doi=10.1056/NEJMcp053247 |url=}}</ref>.
* Relapsing-remitting multiple sclerosis is defined by acute attacks of [[neurological]] [[dysfunction]] followed by full or partial [[recovery]]. Patient clinical [[symptoms]] are stable between the attacks.  
* It can switch to secondary progressive disease when the [[neurological]] [[symptoms]] progressively worsen between the attacks.  
* There is also primary progressive type, which is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks a<nowiki/>nd [[remission]]<nowiki/>s.  
* Progressive relapsing type is a mixture of relapsing and<nowiki/> progression and is defined by progression of [[disease]] from the beginning with acute attack episodes.<ref name="pmid8780061">{{cite journal |vauthors=Lublin FD, Reingold SC |title=Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis |journal=Neurology |volume=46 |issue=4 |pages=907–11 |date=April 1996 |pmid=8780061 |doi= |url=}}</ref>
* The most common [[symptoms]] in all of the [[MS]] patients are [[fatigue]], [[Mood disorders|mood problems]], [[Spasticity|spastici]]<nowiki/>[[Spasticity|ty]], [[bowel]] and [[bladder]] dysfunction, [[cognitive impairment]], [[eye]] [[Movement disorder|movement abnormalities]], heat sensitivity, [[incoordination|incoord]][[incoordination|ination]] , [[pain]]<nowiki/>, [[sexual dysfunction]], [[Sleep disorder|sleep disorders]], [[vertigo]], and [[Vision loss|visual loss]].<ref name="pmid16554529">{{cite journal |vauthors=Balcer LJ |title=Clinical practice. Optic neuritis |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1273–80 |date=March 2006 |pmid=16554529 |doi=10.1056/NEJMcp053247 |url=}}</ref><ref name="pmid25700869">{{cite journal |vauthors=Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P |title=Sleep disorders in patients with multiple sclerosis |journal=J Clin Sleep Med |volume=11 |issue=5 |pages=553–7 |date=April 2015 |pmid=25700869 |pmc=4410929 |doi=10.5664/jcsm.4702 |url=}}</ref><ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref><ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref><ref name="pmid12515563">{{cite journal |vauthors=DasGupta R, Fowler CJ |title=Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies |journal=Drugs |volume=63 |issue=2 |pages=153–66 |date=2003 |pmid=12515563 |doi= |url=}}</ref><ref name="pmid12640060">{{cite journal |vauthors=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=74 |issue=4 |pages=443–6 |date=April 2003 |pmid=12640060 |pmc=1738365 |doi= |url=}}</ref><ref name="pmid15664543">{{cite journal |vauthors=Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S |title=The neuro-ophthalmology of multiple sclerosis |journal=Lancet Neurol |volume=4 |issue=2 |pages=111–21 |date=February 2005 |pmid=15664543 |doi=10.1016/S1474-4422(05)00992-0 |url=}}</ref><ref name="pmid7550931">{{cite journal |vauthors=Selhorst JB, Saul RF |title=Uhthoff and his symptom |journal=J Neuroophthalmol |volume=15 |issue=2 |pages=63–9 |date=June 1995 |pmid=7550931 |doi= |url=}}</ref><ref name="pmid25573524">{{cite journal |vauthors=Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR |title=Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey |journal=BMJ Open |volume=5 |issue=1 |pages=e006714 |date=January 2015 |pmid=25573524 |pmc=4289717 |doi=10.1136/bmjopen-2014-006714 |url=}}</ref><ref name="pmid26087108">{{cite journal |vauthors=Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T |title=The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey |journal=Pain Med |volume=16 |issue=8 |pages=1597–602 |date=August 2015 |pmid=26087108 |doi=10.1111/pme.12731 |url=}}</ref><ref name="pmid26003254">{{cite journal |vauthors=Lew-Starowicz M, Gianotten WL |title=Sexual dysfunction in patients with multiple sclerosis |journal=Handb Clin Neurol |volume=130 |issue= |pages=357–70 |date=2015 |pmid=26003254 |doi=10.1016/B978-0-444-63247-0.00020-1 |url=}}</ref><ref name="pmid17942519">{{cite journal |vauthors=Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M |title=Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage |journal=Mult. Scler. |volume=14 |issue=1 |pages=86–93 |date=January 2008 |pmid=17942519 |doi=10.1177/1352458507080734 |url=}}</ref><ref name="pmid11094117">{{cite journal |vauthors=Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC |title=Vertigo in MS: utility of positional and particle repositioning maneuvers |journal=Neurology |volume=55 |issue=10 |pages=1566–9 |date=November 2000 |pmid=11094117 |doi= |url=}}</ref>


===Complications===
===Complications===
Complications that can develop as a result of mutiple sclerosis are:
[[Complications]] that can develop as a result of mu<nowiki/>tiple sclerosis include:
* Medication complications: Insufficient blood supply to the bone can cause [[Avascular necrosis|avascular osteonecrosis]]. After [[Trauma|trauma,]] [[corticosteroid]] treatment is the most common cause of [[Avascular necrosis|AVN]].<ref name="pmid9365096">{{cite journal |vauthors=Yamamoto T, Irisa T, Sugioka Y, Sueishi K |title=Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits |journal=Arthritis Rheum. |volume=40 |issue=11 |pages=2055–64 |date=November 1997 |pmid=9365096 |doi=10.1002/1529-0131(199711)40:11&lt;2055::AID-ART19&gt;3.0.CO;2-E |url=}}</ref><ref name="pmid12430099">{{cite journal |vauthors=Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME |title=Pathogenesis and natural history of osteonecrosis |journal=Semin. Arthritis Rheum. |volume=32 |issue=2 |pages=94–124 |date=October 2002 |pmid=12430099 |doi= |url=}}</ref>
* [[Medication]] [[complications]]: Insufficient [[blood]] supply to the [[bone]] can cause [[Avascular necrosis|avascular osteonecrosis]]. After [[Trauma|trauma,]] [[corticosteroid]] treatment is the most common cause of [[Avascular necrosis|AVN]].<ref name="pmid9365096">{{cite journal |vauthors=Yamamoto T, Irisa T, Sugioka Y, Sueishi K |title=Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits |journal=Arthritis Rheum. |volume=40 |issue=11 |pages=2055–64 |date=November 1997 |pmid=9365096 |doi=10.1002/1529-0131(199711)40:11&lt;2055::AID-ART19&gt;3.0.CO;2-E |url=}}</ref><ref name="pmid12430099">{{cite journal |vauthors=Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME |title=Pathogenesis and natural history of osteonecrosis |journal=Semin. Arthritis Rheum. |volume=32 |issue=2 |pages=94–124 |date=October 2002 |pmid=12430099 |doi= |url=}}</ref>


* Fatigue: [[Fatigue]] is seen in almost 80% of [[MS]] patients. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.<ref name="pmid16900749">{{cite journal |vauthors=Krupp L |title=Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease |journal=Mult. Scler. |volume=12 |issue=4 |pages=367–8 |date=August 2006 |pmid=16900749 |doi=10.1191/135248506ms1373ed |url=}}</ref>
* Fatigue: [[Fatigue]] is seen in almost 80% of [[MS]] patients. They commonly feel exhausted and out of energy. We can see [[fatigue]] exacerbation before acute attacks in MS and for a while after that.<ref name="pmid16900749">{{cite journal |vauthors=Krupp L |title=Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease |journal=Mult. Scler. |volume=12 |issue=4 |pages=367–8 |date=August 2006 |pmid=16900749 |doi=10.1191/135248506ms1373ed |url=}}</ref>


* Mood problems: [[Psychiatric]] disorders especially [[depression]] is common and can be seen in almost 50% of [[MS]] patients.<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref> Some studies show higher risk of [[suicide]] in [[MS]] patient.<ref name="pmid1866003">{{cite journal |vauthors=Sadovnick AD, Eisen K, Ebers GC, Paty DW |title=Cause of death in patients attending multiple sclerosis clinics |journal=Neurology |volume=41 |issue=8 |pages=1193–6 |date=August 1991 |pmid=1866003 |doi= |url=}}</ref><ref name="pmid1449409">{{cite journal |vauthors=Stenager EN, Stenager E |title=Suicide and patients with neurologic diseases. Methodologic problems |journal=Arch. Neurol. |volume=49 |issue=12 |pages=1296–303 |date=December 1992 |pmid=1449409 |doi= |url=}}</ref>
* Mood problems: [[Psychiatric]] disorders especially [[depression]] is common and can be seen in almost 50% of [[MS]] patients.<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref> Some studies show higher risk of [[suicide]] in [[MS]] patient.<ref name="pmid1866003">{{cite journal |vauthors=Sadovnick AD, Eisen K, Ebers GC, Paty DW |title=Cause of death in patients attending multiple sclerosis clinics |journal=Neurology |volume=41 |issue=8 |pages=1193–6 |date=August 1991 |pmid=1866003 |doi= |url=}}</ref><ref name="pmid1449409">{{cite journal |vauthors=Stenager EN, Stenager E |title=Suicide and patients with neurologic diseases. Methodologic problems |journal=Arch. Neurol. |volume=49 |issue=12 |pages=1296–303 |date=December 1992 |pmid=1449409 |doi= |url=}}</ref>


* Spasticity: Damage to the upper motor neurons and decrease inhibition of lower motor neurons in [[MS]] can increase muscle tone and rigidity in 75% of [[MS]] patients.<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>
* [[Spasticity]]: Damage to the [[Upper motor neuron|upper motor neurons]] and decrease inhibition of [[lower motor neurons]] in [[MS]] can increase [[muscle tone]] and [[Muscle rigidity|rigidity]] in 75% of [[MS]] patients.<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>


* Bowel and bladder dysfunction: [[Bowel]] and [[bladder]] dysfunction is common in [[MS]] patients and occurs in more than 50% of cases.<ref name="pmid12515563">{{cite journal |vauthors=DasGupta R, Fowler CJ |title=Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies |journal=Drugs |volume=63 |issue=2 |pages=153–66 |date=2003 |pmid=12515563 |doi= |url=}}</ref> [[bladder]] dysfunction can be the result of [[Detrusor hyperactivity|Detrusor overactivity]], Detrusor sphincter dyssynergia, Inefficient [[bladder]] [[contractility]] and Abnormal [[sensation]] and [[bladder]] hypoactivity.<ref name="pmid27116728">{{cite journal |vauthors=Wintner A, Kim MM, Bechis SK, Kreydin EI |title=Voiding Dysfunction in Multiple Sclerosis |journal=Semin Neurol |volume=36 |issue=2 |pages=219–20 |date=April 2016 |pmid=27116728 |doi=10.1055/s-0036-1582255 |url=}}</ref> the most common [[bowel]] problems include [[Constipation]], poor [[defecation]] and [[incontinence]].<ref name="pmid10631634">{{cite journal |vauthors=Hennessey A, Robertson NP, Swingler R, Compston DA |title=Urinary, faecal and sexual dysfunction in patients with multiple sclerosis |journal=J. Neurol. |volume=246 |issue=11 |pages=1027–32 |date=November 1999 |pmid=10631634 |doi= |url=}}</ref>
* [[Bowel]] and [[bladder]] dysfunction: [[Bowel]] and [[bladder]] dysfunction is common in [[MS]] patients and occurs in more than 50% of cases.<ref name="pmid12515563">{{cite journal |vauthors=DasGupta R, Fowler CJ |title=Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies |journal=Drugs |volume=63 |issue=2 |pages=153–66 |date=2003 |pmid=12515563 |doi= |url=}}</ref> [[bladder]] dysfunction can be the result of [[Detrusor hyperactivity|Detrusor overactivity]], [[Detrusor muscle|Detrusor]] sphincter dyssynergia, Inefficient [[bladder]] [[contractility]] and Abnormal [[sensation]] and [[bladder]] hypoactivity.<ref name="pmid27116728">{{cite journal |vauthors=Wintner A, Kim MM, Bechis SK, Kreydin EI |title=Voiding Dysfunction in Multiple Sclerosis |journal=Semin Neurol |volume=36 |issue=2 |pages=219–20 |date=April 2016 |pmid=27116728 |doi=10.1055/s-0036-1582255 |url=}}</ref> the most common [[bowel]] problems include [[Constipation]], poor [[defecation]] and [[incontinence]].<ref name="pmid10631634">{{cite journal |vauthors=Hennessey A, Robertson NP, Swingler R, Compston DA |title=Urinary, faecal and sexual dysfunction in patients with multiple sclerosis |journal=J. Neurol. |volume=246 |issue=11 |pages=1027–32 |date=November 1999 |pmid=10631634 |doi= |url=}}</ref>


* Cognitive impairment: [[Cognitive disorder|Cognitive disorders]] is common in [[MS]] patients and can even present at early stages of disease. These disorders are in [[attention]], short term memory, and information processing. Relapsing-remitting type of [[MS]] seems to have a lower [[Cognitive disorder|cognitive problems]].<ref name="pmid12640060">{{cite journal |vauthors=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=74 |issue=4 |pages=443–6 |date=April 2003 |pmid=12640060 |pmc=1738365 |doi= |url=}}</ref><ref name="pmid15774439">{{cite journal |vauthors=Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B |title=Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=76 |issue=4 |pages=519–26 |date=April 2005 |pmid=15774439 |pmc=1739602 |doi=10.1136/jnnp.2004.045872 |url=}}</ref><ref name="pmid2027484">{{cite journal |vauthors=Rao SM, Leo GJ, Bernardin L, Unverzagt F |title=Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction |journal=Neurology |volume=41 |issue=5 |pages=685–91 |date=May 1991 |pmid=2027484 |doi= |url=}}</ref><ref name="pmid15277630">{{cite journal |vauthors=Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH |title=Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS |journal=Neurology |volume=63 |issue=2 |pages=335–9 |date=July 2004 |pmid=15277630 |doi= |url=}}</ref>
* Cognitive impairment: [[Cognitive disorder|Cognitive disorders]] is common in [[MS]] patients and can even present at early stages of disease. These disorders are in [[attention]], short term [[memory]], and information processing. Relapsing-remitting type of [[MS]] seems to have a lower [[Cognitive disorder|cognitive problems]].<ref name="pmid12640060">{{cite journal |vauthors=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=74 |issue=4 |pages=443–6 |date=April 2003 |pmid=12640060 |pmc=1738365 |doi= |url=}}</ref><ref name="pmid15774439">{{cite journal |vauthors=Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B |title=Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=76 |issue=4 |pages=519–26 |date=April 2005 |pmid=15774439 |pmc=1739602 |doi=10.1136/jnnp.2004.045872 |url=}}</ref><ref name="pmid2027484">{{cite journal |vauthors=Rao SM, Leo GJ, Bernardin L, Unverzagt F |title=Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction |journal=Neurology |volume=41 |issue=5 |pages=685–91 |date=May 1991 |pmid=2027484 |doi= |url=}}</ref><ref name="pmid15277630">{{cite journal |vauthors=Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH |title=Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS |journal=Neurology |volume=63 |issue=2 |pages=335–9 |date=July 2004 |pmid=15277630 |doi= |url=}}</ref>


*Heat sensitivity: Patients with [[MS]] disease are more sensitive to heat. A slight increase in [[body temperature]] of these patients will lead to worsening of their [[Sign (medicine)|sign]]<nowiki/>s and [[symptom]]<nowiki/>s.<ref name="pmid7550931">{{cite journal |vauthors=Selhorst JB, Saul RF |title=Uhthoff and his symptom |journal=J Neuroophthalmol |volume=15 |issue=2 |pages=63–9 |date=June 1995 |pmid=7550931 |doi= |url=}}</ref>  
*Heat sensitivity: Patients with [[MS]] disease are more sensitive to heat. A slight increase in [[body temperature]] of these patients will lead to worsening of their [[Sign (medicine)|sign]]<nowiki/>s and [[symptom]]<nowiki/>s.<ref name="pmid7550931">{{cite journal |vauthors=Selhorst JB, Saul RF |title=Uhthoff and his symptom |journal=J Neuroophthalmol |volume=15 |issue=2 |pages=63–9 |date=June 1995 |pmid=7550931 |doi= |url=}}</ref>  
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* Pain: [[Pain]] is a very common [[symptom]] in [[MS]]. Patients can be either from [[neurogenic]] source leading to burning or ice-cold [[dysesthesias]] or from long immobilization and [[spasm]].<ref name="pmid26087108">{{cite journal |vauthors=Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T |title=The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey |journal=Pain Med |volume=16 |issue=8 |pages=1597–602 |date=August 2015 |pmid=26087108 |doi=10.1111/pme.12731 |url=}}</ref><ref name="pmid23318126">{{cite journal |vauthors=Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT |title=Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis |journal=Pain |volume=154 |issue=5 |pages=632–42 |date=May 2013 |pmid=23318126 |doi=10.1016/j.pain.2012.12.002 |url=}}</ref>
* Pain: [[Pain]] is a very common [[symptom]] in [[MS]]. Patients can be either from [[neurogenic]] source leading to burning or ice-cold [[dysesthesias]] or from long immobilization and [[spasm]].<ref name="pmid26087108">{{cite journal |vauthors=Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T |title=The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey |journal=Pain Med |volume=16 |issue=8 |pages=1597–602 |date=August 2015 |pmid=26087108 |doi=10.1111/pme.12731 |url=}}</ref><ref name="pmid23318126">{{cite journal |vauthors=Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT |title=Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis |journal=Pain |volume=154 |issue=5 |pages=632–42 |date=May 2013 |pmid=23318126 |doi=10.1016/j.pain.2012.12.002 |url=}}</ref>


* Sexual dysfunction: [[Sexual dysfunction]] can be due to involvement of [[Motor disorders|motor]] and [[Sensory system|sensory]] pathways or from [[psychological]] problems. Either way, it’s a very common [[symptom]]. In women, we can see reduced [[libido]] and [[orgasm]], [[dyspareunia]] and decrease [[vaginal]] sensation. Presentations of sexual dysfunction in men are decreased [[libido]] and [[premature ejaculation]], [[erectile dysfunction]] and decreased [[Penis|penile]] sensation.<ref name="pmid26003254">{{cite journal |vauthors=Lew-Starowicz M, Gianotten WL |title=Sexual dysfunction in patients with multiple sclerosis |journal=Handb Clin Neurol |volume=130 |issue= |pages=357–70 |date=2015 |pmid=26003254 |doi=10.1016/B978-0-444-63247-0.00020-1 |url=}}</ref><ref name="pmid10618700">{{cite journal |vauthors=Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G |title=Sexual dysfunction in multiple sclerosis: II. Correlation analysis |journal=Mult. Scler. |volume=5 |issue=6 |pages=428–31 |date=December 1999 |pmid=10618700 |doi=10.1177/135245859900500i610 |url=}}</ref>
* Sexual dysfunction: [[Sexual dysfunction]] can be due to involvement of [[Motor disorders|motor]] and [[Sensory system|sensory]] pathways or from [[psychological]] problems. Either way, it’s a very common [[symptom]]. In [[women]], we can see reduced [[libido]] and [[orgasm]], [[dyspareunia]] and decrease [[vaginal]] sensation. Presentations of [[sexual dysfunction]] in [[men]] are decreased [[libido]] and [[premature ejaculation]], [[erectile dysfunction]] and decreased [[Penis|penile]] sensation.<ref name="pmid26003254">{{cite journal |vauthors=Lew-Starowicz M, Gianotten WL |title=Sexual dysfunction in patients with multiple sclerosis |journal=Handb Clin Neurol |volume=130 |issue= |pages=357–70 |date=2015 |pmid=26003254 |doi=10.1016/B978-0-444-63247-0.00020-1 |url=}}</ref><ref name="pmid10618700">{{cite journal |vauthors=Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G |title=Sexual dysfunction in multiple sclerosis: II. Correlation analysis |journal=Mult. Scler. |volume=5 |issue=6 |pages=428–31 |date=December 1999 |pmid=10618700 |doi=10.1177/135245859900500i610 |url=}}</ref>


* Sleep disorders: Many patients with multiple sclerosis suffer from [[sleep disorders]] and daytime [[somnolence]]. This can be the result of so many conditions including [[restless leg syndrome]], [[nocturia]], [[pain]], and medication side effects. Having more cervical lesions lead to experiencing [[restless leg syndrome]] more often.<ref name="pmid17942519">{{cite journal |vauthors=Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M |title=Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage |journal=Mult. Scler. |volume=14 |issue=1 |pages=86–93 |date=January 2008 |pmid=17942519 |doi=10.1177/1352458507080734 |url=}}</ref><ref name="pmid8787103">{{cite journal |vauthors=Amarenco G, Kerdraon J, Denys P |title=[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases] |language=French |journal=Rev. Neurol. (Paris) |volume=151 |issue=12 |pages=722–30 |date=December 1995 |pmid=8787103 |doi= |url=}}</ref><ref name="pmid23078359">{{cite journal |vauthors=Schürks M, Bussfeld P |title=Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis |journal=Eur. J. Neurol. |volume=20 |issue=4 |pages=605–15 |date=April 2013 |pmid=23078359 |doi=10.1111/j.1468-1331.2012.03873.x |url=}}</ref>
* Sleep disorders: Many patients with multiple sclerosis suffer from [[sleep disorders]] and daytime [[somnolence]]. This can be the result of so many conditions including [[restless leg syndrome]], [[nocturia]], [[pain]], and [[medication]] [[side effects]]. Having more [[Cervical spinal nerve|cervical]] lesions lead to experiencing [[restless leg syndrome]] more often.<ref name="pmid17942519">{{cite journal |vauthors=Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M |title=Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage |journal=Mult. Scler. |volume=14 |issue=1 |pages=86–93 |date=January 2008 |pmid=17942519 |doi=10.1177/1352458507080734 |url=}}</ref><ref name="pmid8787103">{{cite journal |vauthors=Amarenco G, Kerdraon J, Denys P |title=[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases] |language=French |journal=Rev. Neurol. (Paris) |volume=151 |issue=12 |pages=722–30 |date=December 1995 |pmid=8787103 |doi= |url=}}</ref><ref name="pmid23078359">{{cite journal |vauthors=Schürks M, Bussfeld P |title=Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis |journal=Eur. J. Neurol. |volume=20 |issue=4 |pages=605–15 |date=April 2013 |pmid=23078359 |doi=10.1111/j.1468-1331.2012.03873.x |url=}}</ref>


* Vertigo: Benign positional paroxysmal [[vertigo]] is the most common cause of [[vertigo]] in an [[MS]] patient. In the course of the disease about 30-50% of patients experience this [[symptom]].<ref name="pmid11094117">{{cite journal |vauthors=Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC |title=Vertigo in MS: utility of positional and particle repositioning maneuvers |journal=Neurology |volume=55 |issue=10 |pages=1566–9 |date=November 2000 |pmid=11094117 |doi= |url=}}</ref>
* Vertigo: Benign positional paroxysmal [[vertigo]] is the most common cause of [[vertigo]] in an [[MS]] patient. In the course of the disease about 30-50% of patients experience this [[symptom]].<ref name="pmid11094117">{{cite journal |vauthors=Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC |title=Vertigo in MS: utility of positional and particle repositioning maneuvers |journal=Neurology |volume=55 |issue=10 |pages=1566–9 |date=November 2000 |pmid=11094117 |doi= |url=}}</ref>


* Visual loss: [[Optic neuritis]] is the most common eye involvement and presents as an [[acute]] unilateral eye [[pain]], followed by some degree of [[vision loss]].<ref name="pmid16554529">{{cite journal |vauthors=Balcer LJ |title=Clinical practice. Optic neuritis |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1273–80 |date=March 2006 |pmid=16554529 |doi=10.1056/NEJMcp053247 |url=}}</ref>
* Visual loss: [[Optic neuritis]] is the most common [[eye]] involvement and presents as an [[acute]] unilateral eye [[pain]], followed by some degree of [[vision loss]].<ref name="pmid16554529">{{cite journal |vauthors=Balcer LJ |title=Clinical practice. Optic neuritis |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1273–80 |date=March 2006 |pmid=16554529 |doi=10.1056/NEJMcp053247 |url=}}</ref>


=== Prognosis ===
=== Prognosis ===
There are some factors associated with a particularly poor [[prognosis]] among [[patients]] with multiple sclerosis. However, we can’t surly say what is the [[prognosis]] of [[MS]] patients.<ref name="pmid24507526">{{cite journal |vauthors=Swanton J, Fernando K, Miller D |title=Early prognosis of multiple sclerosis |journal=Handb Clin Neurol |volume=122 |issue= |pages=371–91 |date=2014 |pmid=24507526 |doi=10.1016/B978-0-444-52001-2.00015-7 |url=}}</ref>
There are some factors associated with a particularly poor [[prognosis]] among [[patients]] with multiple sclerosis. However, we can’t surly say what is the [[prognosis]] of [[MS]] patients.<ref name="pmid24507526">{{cite journal |vauthors=Swanton J, Fernando K, Miller D |title=Early prognosis of multiple sclerosis |journal=Handb Clin Neurol |volume=122 |issue= |pages=371–91 |date=2014 |pmid=24507526 |doi=10.1016/B978-0-444-52001-2.00015-7 |url=}}</ref>
* '''Relapsing versus progressive disease'''
* Relapsing versus progressive disease''':''' Progressive form of [[MS]] seems to have a worse [[prognosis]] in comparison to relapsing remitting form of [[MS]]. [[Disability|Disabilities]] start sooner in progressive form<ref name="pmid8017890">{{cite journal |vauthors=Weinshenker BG |title=Natural history of multiple sclerosis |journal=Ann. Neurol. |volume=36 Suppl |issue= |pages=S6–11 |date=1994 |pmid=8017890 |doi= |url=}}</ref><ref name="pmid11078767">{{cite journal |vauthors=Confavreux C, Vukusic S, Moreau T, Adeleine P |title=Relapses and progression of disability in multiple sclerosis |journal=N. Engl. J. Med. |volume=343 |issue=20 |pages=1430–8 |date=November 2000 |pmid=11078767 |doi=10.1056/NEJM200011163432001 |url=}}</ref><ref name="pmid16434648">{{cite journal |vauthors=Tremlett H, Paty D, Devonshire V |title=Disability progression in multiple sclerosis is slower than previously reported |journal=Neurology |volume=66 |issue=2 |pages=172–7 |date=January 2006 |pmid=16434648 |doi=10.1212/01.wnl.0000194259.90286.fe |url=}}</ref> but some studies showed that age of onset is more important in [[MS]] [[disability]] than the form of the [[disease]].<ref name="pmid16415309">{{cite journal |vauthors=Confavreux C, Vukusic S |title=Age at disability milestones in multiple sclerosis |journal=Brain |volume=129 |issue=Pt 3 |pages=595–605 |date=March 2006 |pmid=16415309 |doi=10.1093/brain/awh714 |url=}}</ref><ref name="pmid16415308">{{cite journal |vauthors=Confavreux C, Vukusic S |title=Natural history of multiple sclerosis: a unifying concept |journal=Brain |volume=129 |issue=Pt 3 |pages=606–16 |date=March 2006 |pmid=16415308 |doi=10.1093/brain/awl007 |url=}}</ref>
Progressive form of [[MS]] seems to have a worse [[prognosis]] in comparison to relapsing remitting form of [[MS]]. Disabilities start sooner in progressive form<ref name="pmid8017890">{{cite journal |vauthors=Weinshenker BG |title=Natural history of multiple sclerosis |journal=Ann. Neurol. |volume=36 Suppl |issue= |pages=S6–11 |date=1994 |pmid=8017890 |doi= |url=}}</ref><ref name="pmid11078767">{{cite journal |vauthors=Confavreux C, Vukusic S, Moreau T, Adeleine P |title=Relapses and progression of disability in multiple sclerosis |journal=N. Engl. J. Med. |volume=343 |issue=20 |pages=1430–8 |date=November 2000 |pmid=11078767 |doi=10.1056/NEJM200011163432001 |url=}}</ref><ref name="pmid16434648">{{cite journal |vauthors=Tremlett H, Paty D, Devonshire V |title=Disability progression in multiple sclerosis is slower than previously reported |journal=Neurology |volume=66 |issue=2 |pages=172–7 |date=January 2006 |pmid=16434648 |doi=10.1212/01.wnl.0000194259.90286.fe |url=}}</ref> but some studies showed that age of onset is more important in [[MS]] [[disability]] than the form of the [[disease]].<ref name="pmid16415309">{{cite journal |vauthors=Confavreux C, Vukusic S |title=Age at disability milestones in multiple sclerosis |journal=Brain |volume=129 |issue=Pt 3 |pages=595–605 |date=March 2006 |pmid=16415309 |doi=10.1093/brain/awh714 |url=}}</ref><ref name="pmid16415308">{{cite journal |vauthors=Confavreux C, Vukusic S |title=Natural history of multiple sclerosis: a unifying concept |journal=Brain |volume=129 |issue=Pt 3 |pages=606–16 |date=March 2006 |pmid=16415308 |doi=10.1093/brain/awl007 |url=}}</ref>
* '''Early symptoms'''
Some first manifestations of [[MS]] disease like [[bowel]] and [[bladder]] dysfunction seem to have a worse [[prognosis]].<ref name="pmid17172607">{{cite journal |vauthors=Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM |title=Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review |journal=Arch. Neurol. |volume=63 |issue=12 |pages=1686–91 |date=December 2006 |pmid=17172607 |doi=10.1001/archneur.63.12.1686 |url=}}</ref>. Another study demonstrated that having so many [[symptoms]] at the onset of the [[disease]] have a worse [[prognosis]] than being mono[[symptom]].<ref name="pmid16401620">{{cite journal |vauthors=Kremenchutzky M, Rice GP, Baskerville J, Wingerchuk DM, Ebers GC |title=The natural history of multiple sclerosis: a geographically based study 9: observations on the progressive phase of the disease |journal=Brain |volume=129 |issue=Pt 3 |pages=584–94 |date=March 2006 |pmid=16401620 |doi=10.1093/brain/awh721 |url=}}</ref>
* '''Demographics'''
Onset of [[MS]] in Black Americans is in later age and they are more susceptible of having multifocal [[signs]] and [[symptoms]] and involvement of [[optic nerve]] and [[spinal cord]].<ref name="pmid15596747">{{cite journal |vauthors=Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL |title=Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis |journal=Neurology |volume=63 |issue=11 |pages=2039–45 |date=December 2004 |pmid=15596747 |doi= |url=}}</ref>
* '''Sex'''
Women seems to have younger age of onset and so better [[prognosis]] than men.<ref name="pmid8017890">{{cite journal |vauthors=Weinshenker BG |title=Natural history of multiple sclerosis |journal=Ann. Neurol. |volume=36 Suppl |issue= |pages=S6–11 |date=1994 |pmid=8017890 |doi= |url=}}</ref>
* '''Smoking'''
Transition of RRMS to SPMS can be accelerated with smoking.<ref name="pmid23628463">{{cite journal |vauthors=Roudbari SA, Ansar MM, Yousefzad A |title=Smoking as a risk factor for development of Secondary Progressive Multiple Sclerosis: A study in IRAN, Guilan |journal=J. Neurol. Sci. |volume=330 |issue=1-2 |pages=52–5 |date=July 2013 |pmid=23628463 |doi=10.1016/j.jns.2013.04.003 |url=}}</ref>
* Lipid specific immunoglobulin level
Lipid specific immunoglobulin level in CSF can predict long term outcomes of [[MS]] disease.<ref name="pmid18755821">{{cite journal |vauthors=Thangarajh M, Gomez-Rial J, Hedström AK, Hillert J, Alvarez-Cermeño JC, Masterman T, Villar LM |title=Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis |journal=Mult. Scler. |volume=14 |issue=9 |pages=1208–13 |date=November 2008 |pmid=18755821 |doi=10.1177/1352458508095729 |url=}}</ref>


* Early [[symptoms]]''':''' Some first manifestations of [[MS]] disease like [[bowel]] and [[bladder]] dysfunction seem to have a worse [[prognosis]].<ref name="pmid17172607">{{cite journal |vauthors=Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM |title=Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review |journal=Arch. Neurol. |volume=63 |issue=12 |pages=1686–91 |date=December 2006 |pmid=17172607 |doi=10.1001/archneur.63.12.1686 |url=}}</ref>. Another study demonstrated that having so many [[symptoms]] at the onset of the [[disease]] have a worse [[prognosis]] than being mono[[symptom]].<ref name="pmid16401620">{{cite journal |vauthors=Kremenchutzky M, Rice GP, Baskerville J, Wingerchuk DM, Ebers GC |title=The natural history of multiple sclerosis: a geographically based study 9: observations on the progressive phase of the disease |journal=Brain |volume=129 |issue=Pt 3 |pages=584–94 |date=March 2006 |pmid=16401620 |doi=10.1093/brain/awh721 |url=}}</ref>
* Demographics''':''' Onset of [[MS]] in Black Americans is in later age and they are more susceptible of having multifocal [[signs]] and [[symptoms]] and involvement of [[optic nerve]] and [[spinal cord]].<ref name="pmid15596747">{{cite journal |vauthors=Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL |title=Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis |journal=Neurology |volume=63 |issue=11 |pages=2039–45 |date=December 2004 |pmid=15596747 |doi= |url=}}</ref>
* Sex''':''' [[Women's College Hospital|Women]] seems to have younger age of onset and so better [[prognosis]] than [[men]].<ref name="pmid8017890">{{cite journal |vauthors=Weinshenker BG |title=Natural history of multiple sclerosis |journal=Ann. Neurol. |volume=36 Suppl |issue= |pages=S6–11 |date=1994 |pmid=8017890 |doi= |url=}}</ref>
* Smoking''':''' Transition of RRMS to SPMS can be accelerated with [[smoking]].<ref name="pmid23628463">{{cite journal |vauthors=Roudbari SA, Ansar MM, Yousefzad A |title=Smoking as a risk factor for development of Secondary Progressive Multiple Sclerosis: A study in IRAN, Guilan |journal=J. Neurol. Sci. |volume=330 |issue=1-2 |pages=52–5 |date=July 2013 |pmid=23628463 |doi=10.1016/j.jns.2013.04.003 |url=}}</ref>
* Lipid specific immunoglobulin level: Lipid specific immunoglobulin level in [[CSF]] can predict long term outcomes of [[MS]] disease.<ref name="pmid18755821">{{cite journal |vauthors=Thangarajh M, Gomez-Rial J, Hedström AK, Hillert J, Alvarez-Cermeño JC, Masterman T, Villar LM |title=Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis |journal=Mult. Scler. |volume=14 |issue=9 |pages=1208–13 |date=November 2008 |pmid=18755821 |doi=10.1177/1352458508095729 |url=}}</ref>
==References==
==References==
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{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Primary care]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Orthopedics]]
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[[Category:Rheumatology]]
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Latest revision as of 22:48, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Multiple sclerosis usually start between age of fifteen to forty years, rarely before age fifteen or after age sixty with symptoms such as optic neuritis, diplopia, sensory or motor loss, vertigo and balance problems. It may be classified into four groups according to clinical course of the disease including relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Complications that can develop as a result of multiple sclerosis are: medication complication, Fatigue, mood problems, Spasticity, Bowel and bladder dysfunction, Cognitive impairment, Heat sensitivity., Incoordination, Pain, Sexual dysfunction, Sleep disorders, vertigo, visual loss. there are some factors associated with a particularly poor prognosis among patients with multiple sclerosis such as: Relapsing versus progressive disease, early symptoms, Demographics, Sex, Smoking.

Natural History, Complications, and Prognosis

Natural History

Complications

Complications that can develop as a result of mutiple sclerosis include:

  • Fatigue: Fatigue is seen in almost 80% of MS patients. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.[18]
  • Vertigo: Benign positional paroxysmal vertigo is the most common cause of vertigo in an MS patient. In the course of the disease about 30-50% of patients experience this symptom.[15]

Prognosis

There are some factors associated with a particularly poor prognosis among patients with multiple sclerosis. However, we can’t surly say what is the prognosis of MS patients.[30]

  • Smoking: Transition of RRMS to SPMS can be accelerated with smoking.[39]
  • Lipid specific immunoglobulin level: Lipid specific immunoglobulin level in CSF can predict long term outcomes of MS disease.[40]

References

  1. ↑ Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC (February 1989). "The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability". Brain. 112 ( Pt 1): 133–46. PMID 2917275.
  2. ↑ Lublin FD, Reingold SC (April 1996). "Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis". Neurology. 46 (4): 907–11. PMID 8780061.
  3. ↑ 3.0 3.1 Balcer LJ (March 2006). "Clinical practice. Optic neuritis". N. Engl. J. Med. 354 (12): 1273–80. doi:10.1056/NEJMcp053247. PMID 16554529.
  4. ↑ Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P (April 2015). "Sleep disorders in patients with multiple sclerosis". J Clin Sleep Med. 11 (5): 553–7. doi:10.5664/jcsm.4702. PMC 4410929. PMID 25700869.
  5. ↑ 5.0 5.1 Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW (March 1996). "Depression and multiple sclerosis". Neurology. 46 (3): 628–32. PMID 8618657.
  6. ↑ 6.0 6.1 Boissy AR, Cohen JA (September 2007). "Multiple sclerosis symptom management". Expert Rev Neurother. 7 (9): 1213–22. doi:10.1586/14737175.7.9.1213. PMID 17868019.
  7. ↑ 7.0 7.1 DasGupta R, Fowler CJ (2003). "Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies". Drugs. 63 (2): 153–66. PMID 12515563.
  8. ↑ 8.0 8.1 Achiron A, Barak Y (April 2003). "Cognitive impairment in probable multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 74 (4): 443–6. PMC 1738365. PMID 12640060.
  9. ↑ Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S (February 2005). "The neuro-ophthalmology of multiple sclerosis". Lancet Neurol. 4 (2): 111–21. doi:10.1016/S1474-4422(05)00992-0. PMID 15664543.
  10. ↑ 10.0 10.1 Selhorst JB, Saul RF (June 1995). "Uhthoff and his symptom". J Neuroophthalmol. 15 (2): 63–9. PMID 7550931.
  11. ↑ 11.0 11.1 Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR (January 2015). "Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey". BMJ Open. 5 (1): e006714. doi:10.1136/bmjopen-2014-006714. PMC 4289717. PMID 25573524.
  12. ↑ 12.0 12.1 Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T (August 2015). "The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey". Pain Med. 16 (8): 1597–602. doi:10.1111/pme.12731. PMID 26087108.
  13. ↑ 13.0 13.1 Lew-Starowicz M, Gianotten WL (2015). "Sexual dysfunction in patients with multiple sclerosis". Handb Clin Neurol. 130: 357–70. doi:10.1016/B978-0-444-63247-0.00020-1. PMID 26003254.
  14. ↑ 14.0 14.1 Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M (January 2008). "Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage". Mult. Scler. 14 (1): 86–93. doi:10.1177/1352458507080734. PMID 17942519.
  15. ↑ 15.0 15.1 Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC (November 2000). "Vertigo in MS: utility of positional and particle repositioning maneuvers". Neurology. 55 (10): 1566–9. PMID 11094117.
  16. ↑ Yamamoto T, Irisa T, Sugioka Y, Sueishi K (November 1997). "Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits". Arthritis Rheum. 40 (11): 2055–64. doi:10.1002/1529-0131(199711)40:11&lt;2055::AID-ART19&gt;3.0.CO;2-E. PMID 9365096.
  17. ↑ Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME (October 2002). "Pathogenesis and natural history of osteonecrosis". Semin. Arthritis Rheum. 32 (2): 94–124. PMID 12430099.
  18. ↑ Krupp L (August 2006). "Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease". Mult. Scler. 12 (4): 367–8. doi:10.1191/135248506ms1373ed. PMID 16900749.
  19. ↑ Sadovnick AD, Eisen K, Ebers GC, Paty DW (August 1991). "Cause of death in patients attending multiple sclerosis clinics". Neurology. 41 (8): 1193–6. PMID 1866003.
  20. ↑ Stenager EN, Stenager E (December 1992). "Suicide and patients with neurologic diseases. Methodologic problems". Arch. Neurol. 49 (12): 1296–303. PMID 1449409.
  21. ↑ Wintner A, Kim MM, Bechis SK, Kreydin EI (April 2016). "Voiding Dysfunction in Multiple Sclerosis". Semin Neurol. 36 (2): 219–20. doi:10.1055/s-0036-1582255. PMID 27116728.
  22. ↑ Hennessey A, Robertson NP, Swingler R, Compston DA (November 1999). "Urinary, faecal and sexual dysfunction in patients with multiple sclerosis". J. Neurol. 246 (11): 1027–32. PMID 10631634.
  23. ↑ Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B (April 2005). "Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 76 (4): 519–26. doi:10.1136/jnnp.2004.045872. PMC 1739602. PMID 15774439.
  24. ↑ Rao SM, Leo GJ, Bernardin L, Unverzagt F (May 1991). "Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction". Neurology. 41 (5): 685–91. PMID 2027484.
  25. ↑ Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH (July 2004). "Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS". Neurology. 63 (2): 335–9. PMID 15277630.
  26. ↑ Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (May 2013). "Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis". Pain. 154 (5): 632–42. doi:10.1016/j.pain.2012.12.002. PMID 23318126.
  27. ↑ Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G (December 1999). "Sexual dysfunction in multiple sclerosis: II. Correlation analysis". Mult. Scler. 5 (6): 428–31. doi:10.1177/135245859900500i610. PMID 10618700.
  28. ↑ Amarenco G, Kerdraon J, Denys P (December 1995). "[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases]". Rev. Neurol. (Paris) (in French). 151 (12): 722–30. PMID 8787103.
  29. ↑ Schürks M, Bussfeld P (April 2013). "Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis". Eur. J. Neurol. 20 (4): 605–15. doi:10.1111/j.1468-1331.2012.03873.x. PMID 23078359.
  30. ↑ Swanton J, Fernando K, Miller D (2014). "Early prognosis of multiple sclerosis". Handb Clin Neurol. 122: 371–91. doi:10.1016/B978-0-444-52001-2.00015-7. PMID 24507526.
  31. ↑ 31.0 31.1 Weinshenker BG (1994). "Natural history of multiple sclerosis". Ann. Neurol. 36 Suppl: S6–11. PMID 8017890.
  32. ↑ Confavreux C, Vukusic S, Moreau T, Adeleine P (November 2000). "Relapses and progression of disability in multiple sclerosis". N. Engl. J. Med. 343 (20): 1430–8. doi:10.1056/NEJM200011163432001. PMID 11078767.
  33. ↑ Tremlett H, Paty D, Devonshire V (January 2006). "Disability progression in multiple sclerosis is slower than previously reported". Neurology. 66 (2): 172–7. doi:10.1212/01.wnl.0000194259.90286.fe. PMID 16434648.
  34. ↑ Confavreux C, Vukusic S (March 2006). "Age at disability milestones in multiple sclerosis". Brain. 129 (Pt 3): 595–605. doi:10.1093/brain/awh714. PMID 16415309.
  35. ↑ Confavreux C, Vukusic S (March 2006). "Natural history of multiple sclerosis: a unifying concept". Brain. 129 (Pt 3): 606–16. doi:10.1093/brain/awl007. PMID 16415308.
  36. ↑ Langer-Gould A, Popat RA, Huang SM, Cobb K, Fontoura P, Gould MK, Nelson LM (December 2006). "Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review". Arch. Neurol. 63 (12): 1686–91. doi:10.1001/archneur.63.12.1686. PMID 17172607.
  37. ↑ Kremenchutzky M, Rice GP, Baskerville J, Wingerchuk DM, Ebers GC (March 2006). "The natural history of multiple sclerosis: a geographically based study 9: observations on the progressive phase of the disease". Brain. 129 (Pt 3): 584–94. doi:10.1093/brain/awh721. PMID 16401620.
  38. ↑ Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL (December 2004). "Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis". Neurology. 63 (11): 2039–45. PMID 15596747.
  39. ↑ Roudbari SA, Ansar MM, Yousefzad A (July 2013). "Smoking as a risk factor for development of Secondary Progressive Multiple Sclerosis: A study in IRAN, Guilan". J. Neurol. Sci. 330 (1–2): 52–5. doi:10.1016/j.jns.2013.04.003. PMID 23628463.
  40. ↑ Thangarajh M, Gomez-Rial J, Hedström AK, Hillert J, Alvarez-Cermeño JC, Masterman T, Villar LM (November 2008). "Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis". Mult. Scler. 14 (9): 1208–13. doi:10.1177/1352458508095729. PMID 18755821.

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