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Has reviewed over 250 cases and testified in dozens of depositions and trials

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[DOI] [PMC free article] [PubMed] [Google Scholar] 19.Mezey ., Eisenhofer G., Hansson S., Hunyady B., Hoffman B.J

[DOI] [PMC free article] [PubMed] [Google Scholar] 19.MacRedmond R, Singhera G, Attridge S, Bahzad M, Fava C, Lai Y, et al

What happens in MS * Immune system damages myelin * Forms sclerosis (scar plaques) * Slows or blocks nerve impulses * Leads to neurological dysfunction depending on location Common symptoms Symptoms vary widely depending on which nerves are affected: Motor & sensory * Weakness in limbs * Numbness or tingling * Loss of coordination (ataxia) * Muscle stiffness (spasticity) Visual * Optic neuritis (painful vision loss, blurred vision) * Double vision Other * Fatigue (very common) * Bladder or bowel dysfunction * Cognitive changes (memory, attention problems) * Electric shock sensation down spine when bending neck (Lhermitte sign) Types of MS * Relapsing-remitting MS (RRMS): attacks followed by recovery (most common) * Secondary progressive MS (SPMS): starts relapsing, then slowly worsens * Primary progressive MS (PPMS): steady worsening from onset Causes & risk factors Exact cause is unknown, but involves: * Autoimmune dysfunction * Genetic predisposition * Viral triggers (e.g., Epstein-Barr virus association) * Low vitamin D / less sunlight exposure * More common in young adults and females Diagnosis No single testcombination of: * MRI brain/spine: shows demyelinating plaques * Lumbar puncture: oligoclonal bands in CSF * Evoked potential tests (nerve conduction delays) * Clinical history of dissemination in time and space Treatment There is no cure, but treatment slows progression and controls relapses: Disease-modifying therapy * Interferon beta-1a * Glatiramer acetate * Ocrelizumab Relapse treatment * High-dose corticosteroids (e.g., methylprednisolone) Symptom management * Muscle relaxants for spasticity * Physiotherapy and rehabilitation * Fatigue management strategies Complications * Progressive disability * Mobility problems * Vision impairment * Cognitive decline in advanced stages MS is a misdirected immune attack on nerve insulation nerve signals slow down or fail neurological symptoms appear in unpredictable patterns

Formulate differential diagnoses and then work backward or forward to determine the most appropriate next steps in diagnosis or treatment