Disease subtypes

Relapsing-remitting

Primary progressive

Secondary progressive

Clinical features

Peak age at disease onset: 20 to 45 years

Episodic neurologic symptoms involving discrete areas separated by time

Ophthalmic (common at onset)

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  Internuclear ophthalmoplegia (diplopia on lateral gaze)

  
  
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  Diplopia

  
  
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  Optic atrophy

  
  
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  Nystagmus

  
  
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  Retrobulbar neuritis

Neurologic

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  Weakness/spastic paresis

  
  
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  Numbness

  
  
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  Tingling

  
  
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  Dysarthria

  
  
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  Ataxia

  
  
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  Incoordination

  
  
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  Scanning speech

  
  
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  Dysdiadochokinesia

  
  
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  Intention tremor

  
  
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  Sphincter disturbance (e.g., urinary urgency, hesitancy)

Psychiatric manifestations

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  Suicidality (increased risk in male patients, early onset of disease, recent diagnosis)

  
  
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  Depression

  
  
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  Mania

  
  
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  Anxiety

  
  
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  Cognitive impairment (e.g., deficits in memory, attention, information-processing speed, learning, executive functions)

  
  
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  Euphoria

  
  
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  Emotional lability

  
  
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  Personality changes (e.g., increased irritability, apathy)

  
  
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  Rare psychosis

Diagnostic findings

MRI—multiple focal periventricular areas of demyelination

Cerebrospinal fluid—elevated myelin basic protein, elevated immunoglobulin, presence of oligoclonal bands

Abnormal visual/somatosensory evoked potentials

Management

Consult and coordinate care with neurology

Closely monitor and manage psychiatric illness, with careful attention for risk of suicidality

Treatment may include managing symptoms (e.g., pain, bladder dysfunction) and immune-modulating therapies including β-interferon and corticosteroids