MS is a condition that can progress consistently or sporadically through cycles of exacerbations (when the condition is acute) and remissions (where there are hardly any evidence of the disease). In exacerbations new symptoms can develop over several days or weeks and then often resolve themselves in part or in whole. During remission, the patient has no symptoms for many months or years.  The rate at which the disease progresses varies from person to person. 4 Main Types of Multiple Sclerosis Relapsing- remitting: Most common form of MS, accounts for 85% of all cases. Patients experience acute exacerbations, that may or may not leave permanent damage and disabilities, followed by periods of remission. Progressive- relapsing: MS that is consistently getting worse and includes periods of acute episodes Secondary progressive: Begins as relapsing remitting, but then progresses to a constant steady decline without remission phases. Around 60-70 percent of individuals who have relapsing-remitting multiple sclerosis will go on to have secondary progression. Primary progressive: Steady decline in medical health without periods of exacerbations and remissions

Exact causes of MS are still elusive but both genetic and environmental factors have been attributed in the etiology of MS. Genetics : Genome wide association studies (GWAS) have uncovered over 100 genetic loci associated with MS, accounting for ~30% of the disease risk. Majority of these genes belong to the immunological pathways. Among these, human leukocyte antigen HLA-DRB1*15.01 is the most significant genetic susceptibility locus for MS and may increase in the MS risk by threefold. MS has an overall familial recurrence rate of 20%. The concordance rate among monozygotic twins is 24-30% and in dizygotic twins is 3-5%. In addition to siblings, MS is also prevalent in first and second degree relatives. Environmental factors : Smoking, low Vitamin D levels, and Epstein–Barr virus (EBV) infection are the best-known environmental factors contributing to MS. Smoking: Cigarette smoking has shown to increase the risk of autoimmune diseases including MS. Duration as well as intensity of smoking independently increase the risk of MS.  Smokers are twice as likely to develop MS in comparison to non-smokers. Moreover, passive smoking also increases the risk of MS. EBV: A significant number of patients with MS show EBV responsive antibodies in their serum. Moreover, EBV-specific CD8+ T-cell responses are significantly higher in patients with MS than in healthy volunteers.

MS can be acute, affecting all activities of daily living or it can go into remission so that the patient has no symptoms at all. Common symptoms of multiple sclerosis include: Blurred, double, and even loss of vision Weakness or numbness Pain or tingling it various parts of the body, often arm or leg Stiffness and spasticity with movement Dizziness Loss of coordination and decreased balance, which leads to unsteady gait Fatigue, emotional changes, depression Bladder and bowel function issues Weakness Cognitive changes,

Timely and accurate diagnosis of demyelinating central nervous system diseases like multiple sclerosis is of paramount importance and has a huge bearing on patients’ outcomes and their ensuing quality of life. Considerable effort has been placed on the diagnostic process and formal guidelines has been developed. Nevertheless, the diagnosis of multiple sclerosis is predominantly based on history, clinical manifestations, laboratory studies, and imaging. The enigmatic nature of Multiple Sclerosis coupled with the poor understanding of its pathophysiology has limited diagnostic and treatment advances. There is currently no definitive diagnostic test to recognize the disease. Evolution of Multiple Sclerosis Diagnosis In 1868, a French neurologist Jean-Martin Charcot, described clinical features typical for multiple sclerosis as telegraphic (scanning) speech, nystagmus and intention tremor in what became known as Charcot’s triad. Although this triad was said to be characteristic of multiple sclerosis, it typically occurred in very advanced disease and was akin to other neurological disorders that involved damage to the cerebellum. In 1906, an Austrian neurologist Otto Marburg affirmed that a lack of the plantar reflex, observation of Uhthoff’s sign (temporary deterioration of neurological symptoms attributed to a rise in the body’s core temperature) and pyramidal signs were sufficient to diagnose multiple sclerosis.

Multiple sclerosis is a lifelong disease that requires various modalities of treatment. Plan of care considerations include (1) the patient’s age at onset of illness; (2) sex; (3) the extent of the disability at the time of diagnosis as well as (4) the form of multiple sclerosis. Treatment will be a multidisciplinary approach that involves specialists such as neurologists, rehabilitation specialists, neuro-urology experts, psychiatrists, occupational therapists, physiotherapists and social workers. This method is essential to ensure that all aspects of the disease are considered to help improve their quality of life. The management of multiple sclerosis consists of a four-prong approach that involves: (1) management of acute exacerbations; (2) reduction of the frequency of relapses; (3) administration of the complications and (4) management of permanent disability that has already occurred.  These are the goals of the management. No cure for the disease has been established. Management of Acute Exacerbations (index demyelinating episodes) High-dose steroids such as corticosteroids are the cornerstone of treating acute exacerbations because they reduce and control inflammation. Steroids are generally reserved for patients with exacerbations severe enough to cause functional disability or in those that exacerbations are prolonged beyond the duration of 24 hours. Corticosteroids work by reducing the inflammation which is a primary cause of the systems of multiple sclerosis.