Multiple sclerosis is a recurrent (occasionally progressive) inflammatory demyelenization of the white matter of the brain and spinal cord resulting in multiple and varied neurological symptoms. The usual course is intermittent, progressive and relapsing. Multiple sclerosis predominantly affects young men between the ages of 16 and 40.
The cause is unknown. Several theories have been proposed. The autoimmune theory (autoimmune attack of myelin basic protein by T cells or tumor necrosis factor alpha) is supported by HLA linkage, hereditary pattern, immunocytes in plaques, and changes in peripheral blood immunocytes. The viral theory is supported by increasing incidence of disease at higher latitudes, clusters of cases with families, geographical clusters of cases, and animal studies of infectious diseases of myelin. The combined theory involves an autoimmune disorder triggered by environmental exposure to toxin or virus early in life.
Risk factors for multile sclerosis include: Living in temperate zone; Northern European descent; and a Family history of the disease.
Tests of the cerebrospinal fluid show an abnormal colloidal gold curve, elevated gamma globulin IgG, mild mononuclear pleocytosis (less than 40 cells/mL), myelin debris, and normal or slightly elevated protein of 50-100 mg/100 mL (50-100 mg/dL [500-1000 mg/L]). Serology for syphilis is negative.
Tests to exclude other disorders include: Fluorescent treponemal antibody absorption (FTAABS); Sedimentation rate; Screens for clinically suspected vasculitic disorders; and Human T-lymphotropic virus-1 (HTLV-l) serology.
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