TY - JOUR
T1 - Multiple Sclerosis
T2 - An Emergency Medicine-Focused Narrative Review
AU - Pelletier, Jessica
AU - Sugar, Davis
AU - Koyfman, Alex
AU - Long, Brit
N1 - Publisher Copyright:
© 2023
PY - 2024/4
Y1 - 2024/4
N2 - Background: Multiple sclerosis (MS) is a rare but serious condition associated with significant morbidity. Objective: This review provides a focused assessment of MS for emergency clinicians, including the presentation, evaluation, and emergency department (ED) management based on current evidence. Discussion: MS is an autoimmune disorder targeting the central nervous system (CNS), characterized by clinical relapses and radiological lesions disseminated in time and location. Patients with MS most commonly present with long tract signs (e.g., myelopathy, asymmetric spastic paraplegia, urinary dysfunction, Lhermitte's sign), optic neuritis, or brainstem syndromes (bilateral internuclear ophthalmoplegia). Cortical syndromes or multifocal presentations are less common. Radiologically isolated syndrome and clinically isolated syndrome (CIS) may or may not progress to chronic forms of MS, including relapsing remitting MS, primary progressive MS, and secondary progressive MS. The foundation of outpatient management involves disease-modifying therapy, which is typically initiated with the first signs of disease onset. Management of CIS and acute flares of MS in the ED includes corticosteroid therapy, ideally after diagnostic testing with imaging and lumbar puncture for cerebrospinal fluid analysis. Emergency clinicians should evaluate whether patients with MS are presenting with new-onset debilitating neurological symptoms to avoid unnecessary testing and admissions, but failure to appropriately diagnose CIS or MS flare is associated with increased morbidity. Conclusions: An understanding of MS can assist emergency clinicians in better diagnosing and managing this neurologically devastating disease.
AB - Background: Multiple sclerosis (MS) is a rare but serious condition associated with significant morbidity. Objective: This review provides a focused assessment of MS for emergency clinicians, including the presentation, evaluation, and emergency department (ED) management based on current evidence. Discussion: MS is an autoimmune disorder targeting the central nervous system (CNS), characterized by clinical relapses and radiological lesions disseminated in time and location. Patients with MS most commonly present with long tract signs (e.g., myelopathy, asymmetric spastic paraplegia, urinary dysfunction, Lhermitte's sign), optic neuritis, or brainstem syndromes (bilateral internuclear ophthalmoplegia). Cortical syndromes or multifocal presentations are less common. Radiologically isolated syndrome and clinically isolated syndrome (CIS) may or may not progress to chronic forms of MS, including relapsing remitting MS, primary progressive MS, and secondary progressive MS. The foundation of outpatient management involves disease-modifying therapy, which is typically initiated with the first signs of disease onset. Management of CIS and acute flares of MS in the ED includes corticosteroid therapy, ideally after diagnostic testing with imaging and lumbar puncture for cerebrospinal fluid analysis. Emergency clinicians should evaluate whether patients with MS are presenting with new-onset debilitating neurological symptoms to avoid unnecessary testing and admissions, but failure to appropriately diagnose CIS or MS flare is associated with increased morbidity. Conclusions: An understanding of MS can assist emergency clinicians in better diagnosing and managing this neurologically devastating disease.
KW - Clinically isolated syndrome (CIS)
KW - Emergency medicine
KW - Multiple sclerosis (MS)
KW - Neurology
KW - Radiologically isolated syndrome (RIS)
UR - http://www.scopus.com/inward/record.url?scp=85187575294&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85187575294&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2023.12.003
DO - 10.1016/j.jemermed.2023.12.003
M3 - Article
C2 - 38472027
AN - SCOPUS:85187575294
SN - 0736-4679
VL - 66
SP - e441-e456
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 4
ER -