Daniel M. Harrison, MD
CME Objective: To review current evidence for diagnosis and treatment of multiple sclerosis.
Funding Source: American College of Physicians.
Disclosures: Dr. Harrison, ACP Contributing Author, has disclosed the following conflicts of interest: Personal fees: MedImmune, Questcor; Grants: Bayer Neurosciences, Merck-Serono. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0547.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
With the assistance of additional physician writers, Annals of Internal Medicine editors develop In the Clinic using resources of the American College of Physicians, including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program).
Harrison D.; Multiple Sclerosis. Ann Intern Med. 2014;160:ITC4-1. doi: 10.7326/0003-4819-160-7-201404010-01004
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Published: Ann Intern Med. 2014;160(7):ITC4-1.
Multiple sclerosis (MS) is an autoimmune condition that results in inflammatory damage to the central nervous system (CNS). The pathologic hallmarks of MS are diffuse and focal areas of inflammation, demyelination, gliosis, and neuronal injury in the optic nerves, brain, and spinal cord. In addition to affecting white matter tracts, MS results in injury to the cortical and deep gray matter. The neurologic symptoms and disability that patients with MS experience are a direct consequence of these pathologic processes, resulting in acute and chronic disruption of white matter tracts and gray matter structures.
MS is the most common nontraumatic cause of neurologic disability in persons younger than 40 years, with an estimated prevalence of 400 000 in the United States (1). It occurs in a female–male ratio of 3 to 1 (1). The cause of MS is multifactorial and is probably the cumulative result of multiple genetic and environmental risk factors. Twin studies have shown concordance rates between 20% and 30% in monozygotic twins and between 2% and 3% in dizygotic twins (2). Genome-wide assays have identified risk alleles in genes for major histocompatibility complex, interleukin-2 receptor, and interleukin-7 receptor, among others (3, 4). Geographic location of residence before adolescence is also predictive of MS risk, with increased rates of the disease in northern and southern latitudes compared with equatorial countries. Reduced sunlight exposure in these regions may explain some of this distribution. Because ultraviolet radiation to the skin is the major source of vitamin D synthesis, living in regions with low levels of seasonal sunlight is associated with an increased risk for MS in individuals with vitamin D deficiency (5). Risk may also be influenced by exposure or lack of exposure to particular infectious agents because antibodies against certain viruses (such as Epstein–Barr virus) are more frequently seen in patients with MS than in those without it (6).
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Neurology, Multiple Sclerosis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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