1. Pathophysiology
   1. Auto immune with possible genetic link
   2. Chronic degenerative disease of CNS
   3. demyelination of nerve fibers
   4. Cause unknown
   5. Possible environmental link combine with genetic susceptibility
   6. Early damaged myelin can regenerate
   7. sclerotic plaques eventually form disrupting nerve signals
   8. Periods of remission and exacerbation
2. Clinical Manifestations
   1. Gradual and vague onset
   2. Motor Sx
      1. Weakness of limbs, trunk, or head
      2. Diplopia
      3. Spastic muscles
   3. Sensory Sx
      1. Numbness and tingling
      2. patchy blindness (scotomas)
      3. blurred vision
      4. vertigo
      5. tinnitus
      6. neuropathic pain
   4. Cerebella Sx
      1. Nystagmus
      2. ataxia
      3. Dysarthria (distorted speech)
      4. Dysphagia
   5. Bowel and Bladder
      1. Constipation
      2. Spastic bladder
   6. Emotional Signs
      1. Intellect usually intact
      2. anger, depression
      3. euphoria
3. Diagnostic
   1. No definitive test
   2. Based on and symptoms
   3. Sclerotic plaques on MRI
   4. CSF may have incr. IgG
   5. Delayed evoked potential response
4. Drug therapy
   1. For acute exacerbations
      1. Adrenocorticotropic hormone (ACTH)
      2. methylprednisolone (Medrol)
      3. Subtopic 3
   2. Immunosuppressive drugs
      1. azathioprine (Imuran)
      2. methotrexate
      3. cyclophosphamide (Cytoxin)
   3. Immunomodulator drugs
      1. interferon beta-1b (Betaseron)
      2. interferon beta-1a (Avonex, Rebif)
      3. glatiramer acetate (Copaxone)