Pathophysiology
T- and B-cell mediated demyelination and axonal loss. Risk: EBV infection, low vitamin D, smoking, HLA-DRB1*15:01.
Sources: McDonald 2017 (Lancet Neurol 2018;17:162); AAN DMT Guideline 2018
Presentation
Optic neuritis (painful monocular vision loss), internuclear ophthalmoplegia, Lhermitte sign, sensory-motor deficits, bladder dysfunction; 85% relapsing-remitting.
Diagnosis
2017 McDonald criteria: dissemination in space and time on MRI (periventricular, juxtacortical, infratentorial, spinal cord) plus CSF oligoclonal bands.
Management
Acute relapse: IV methylprednisolone. Disease-modifying: high-efficacy (ocrelizumab, natalizumab, ofatumumab) preferred early over interferon-beta, glatiramer, teriflunomide.
