The nature of the disease

MS is characteristically a disease of young adults. The etiology remains unknown but both genetic and environmental factors probably contribute; the histopathologic lesion is a central nervous system (CNS) perivenular inflammatory demyelination consistent with an autoimmune response directed at myelin antigens. These lesions can occur almost anywhere in the CNS, accounting for the great diversity of clinical presentation seen in this disease. The clinical course is notoriously variable, but is typically relapsing/remitting with a tendency to cumulative neurologic deficit as the disease progresses. Optic neuritis or peripheral paresthesiae are the most common presenting features. Rarely, pain is the first clinical manifestation of the disease.3 Motor and/or cerebellar symptoms tend to present later and are associated with a poorer prognosis. Approximately one-third of patients do not develop permanent functional impairment and less than one-third will become severely disabled. Typical features of the severe advanced case include spastic paraparesis or tetraparesis, variable somatosensory deficits, cerebellar ataxia with scanning dysarthria, incontinence, disorders of mood, and cognitive impairment.

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