الفهرس 
Multiple Sclerosis: Clinical Features, Pathophysiology,Only 14 pages are availabe for public view
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Abstract
Multiple sclerosis is a demylinating disease, the commonest of all conditions that destroys myelin in the central nervous system, affecting young people between the age of twenty and forty and it is the leading disabling disease in young people.
The Etiology of multiple sclerosis is thought to involve interplay between genetic and environmental factors resulting in an immunologicaly mediated inflammatory responses within the central nervous system
The disease is characterized clinically by episodes of focal disorders of the optic nerve, spinal cord, and brain which remit to a varying extent and recur over a period of many years.
MS is diagnosed by the presence of the clinical episodes and confirm the diagnosis by the help of MRI and CSF examinatrion.
MS may be presented several psy¬chiatric disorders which disturb mainly mood, behavior and personality. Among those disorders, depression is the most frequently related. Psychiatric symptoms are com¬monly observed during disease evolution but they are un¬usual as first symptoms and the estimated occurrence rate was 1% of cases approximately. In many cases, MS is wrong¬ly diagnosed as pure psychiatric disorder.
Cognitive impairment may be considered the most severe effect of MS it affects the MS patients level of functioning.
This work includes a review of literature about multiple sclerosis and a practical part.
In the first chapter concerning review of the literature we present the disease as Pathogenesis including the etiology, Genetic epidemiology of Multiple sclerosis, clinical picture and different MS types , MS symptoms we focused on fatigue as the most prevalent MS symptom. We also discussed the different investigations used to fully diagnose MS starting from MRI, Evoked potentials and CSF examinations and summarize the diagnostic criteria of MS. At the end of this chapter we discussed the different modalities to treat MS and finally with the future MS therapies.
Chapter II: we discussed the psychiatric presentations of the disease including affective disorders especially depression its etiology in MS, and effect on physical disabilities and cognitive impairment, its relation to fatigue and how to treat depression in MS patients. Also we focused on other affective disorders such as bipolar disorders, mania and euphoria, mania pathological laughing and weeping, Emotional lability and psychosis. We also discussed the cognitive impairment in MS its prevalence and the possibility to consider it a form of subcortical dementia, also cognitive dysfunctions and its relation to pain and correlations with MRI findings in MS patients and how to treat cognitive impairment in MS.
Concerning the practical part: 25 patients diagnosed as definite MS were taken from (El-Maady Armed Forces Hospital MS clinic) aiming for neuropsychiatric and MRI assessment. Clinical diagnosis done using the McDonald criteria , SCID-I. , EDSS scale and the MMSE.
The results showed that among the MS symptoms, fatigue was the most prevalent (94%), sphincteric troubles come next (80%) then visual symptoms were (76%), 64% showed dizziness, 60% of them had sexual dysfunction and 56% of them had pain. Regarding the psychiatric doisorders we found that depression, dysthymia, GAD were the most common, it occurred in about 60% of patients, but compulsions, panic disorders, hallucinations was the least to be found in about 8-20 %.
Regarding the cognitive dysfunctions it was found that most patients (72%) had MMSE score above 25, (24%) of patient showed MMSE score between 17-25 and (4%) of them showed scores less than 17.
While concerning the degree of physical disability we found that EDSS was in range of 0.5 – 8. EDSS was less than 3 in (44%) of cases that means moderate disability in one functional system. EDSS grade 3-6 was found in 32% of cases that means from moderate disability till intermittent or constant unilateral assistance (cane, crutch, or brace). EDSS grade more than 6 was found in (24%) of cases that means constant bilateral support down to essentially restricted to bed.
When we come to the correlations:
We found that there is high correlation between RRMS with depression, dysthymia, and GAD but without statistical significanc.
There is high correlations between dysthymia and panic disorder and increasing age but without statistical significance, but least statistically significant with depression. There is high correlation between increasing age and SCID mania but with no statistical significance, but statistical significance with hypomania.
There is statistical significance correlation between increasing disease duration and SCID panic and hypochondriasis, but other SCID results showed no statistical significance.
But there is statistical significance between attack number and somatization.
There is high correlation between increased no of MS attacks and mania, hypomania, panic, obsessions, hypochondriasis and delusions. But without statistical significance.,
There is high correlation between high EDDS and depression, mania but with no statistical significance. There is high correlation between low EDDS and dysthymia, obsessions, GAD, somatization, delusions, hallucinations but with n o statistical significance.
There is correlation between all SCID dysfunctions and high MMSE but with no statistical significance.
There is correlation between pain and depression, dysthymia, panic, obsessions, GAD, hypochondriasis, but with no statistical significance.
But there is statistical significance correlation between absence of pain and mania.
There are significant correlations between the presence of sexual dysfunction and depression dysthymia, panic, GAD, somatization, hypochondriais, and delusions but without statistical significance.
There are statistical significance correlations between hallucinations and fatigue, but statistical non-significant correlation between fatigue and all other SCID dysfunctions.
There is statistical nonsignificant correlation between increasing MRI plaque No and mania, hypomania, panic, hypochondriasis, and hallucinations.
But there is mild statistical significance correlation between decrease plaque no and depression and dysthymia.