25. Multiple sclerosis and related disorders

Multiple sclerosis is a disease of the central nervous system. It is the most common cause of disability among young adults in the Western world. It is characterized by a wide variety of neurological symptoms and signs, a combination of new transient symptoms and gradually progressive loss of function over a lengthy period. There are several types of disease course. The diagnostic criteria are abnormalities that are dissociated in time and place. MRI is the most important diagnostic test. There is no causal treatment for MS as yet, although there are immunomodulatory and immunosuppressive treatments. There are also symptomatic treatments. MS needs to be distinguished from other demyelinating disorders. Following a general discussion of MS in sect. 25.2–25.4, the clinical symptoms of MS are dealt with in sect. 25.2. The diagnostic criteria are presented in sect. 25.5. MS therapy is flourishing. It is discussed in the next section (sect. 25.6), but only in outline. If a white matter (myelin) disorder is diagnosed, MS is not the only possibility (sect. 25.7). In addition, various other disorders have multiple neurological symptoms that could be consistent with MS, but these have a different autoimmune genesis. These disorders are discussed at the end of this chapter (sect. 25.8).