Talk:Multiple sclerosis

My first Citizendium article

This is the very first article I've edited in Citizendium, so don't be surprised if some edits are rather Wikipedia-edits than pure Citizendium ones. Feel free to inform me if such is the case. Mikael Häggström 12:59, 25 July 2007 (CDT)

Hello again Mikael, if you imported it from wikipedia, don't forget to check the checkbox at the bottom of the edit page. Note that you have to make some slight edit to make it show up. That gives the credit to wikipedia. If you end up changing the enitire thing, then you can uncheck the box. Also, if you need some help with the CZ:The Article Checklist let me know. --Matt Innis (Talk) 13:33, 25 July 2007 (CDT)

Looks like wikipedia origin. Tom Kelly 01:32, 26 July 2007 (CDT)

Hi Tom! I went ahead and added from wikipedia and put the cats on. --Matt Innis (Talk) 09:03, 26 July 2007 (CDT)

The checklist

I've done a scan of the article, and made adits where I've found it appropriate, in addition to the basic changes stated in CZ:The Article Checklist. I wasn't sure if the article should be rated with 1 or 2 - it was a featured article in Wikipedia, and I've gone through it and I find everything reasonable. However, I rated it as 2, just in case. Mikael Häggström 02:24, 29 July 2007 (CDT)

Underlinked

The article is a subarticle to demyelinating disease. However, that article doesn't exist yet, so I changed the article to underlinked. Mikael Häggström 05:22, 29 July 2007 (CDT)

Reorganizing

Did some cleaning. Feel free to revert. Arguable change I did was moving "Signs and Symptoms" to be located within 'Diagnosis'

Let me put out some general observations before going extensively to the literature.

First, I think it is important to establish that it is a demyelinating disease of central, not peripheral, neurons. Objective demonstration of peripheral neuropathy is a reason to look much harder for alternative diagnoses, such as a vasculitis, CMT genetic abnormalities (e.g., hereditary multiple pressure palsy), or metabolic disorders. Behcet's Syndrome can be confusing, or indeed comorbid with MS.

Second, clinical diagnosis alone can be suspect in the presence of comorbidities. I don't think anyone would any longer make the DX based on nystagmus on lateral gaze, but, I've seen patients, with a positive electronystagmogram, had MS ruled out when records of childhood nystagmus were found. Some of these patients also had a CNS disorder, such as CNS-isolated vasculitis. Anecdotally, I know several MS subspecialists where a history of childhood seizure disorder makes them look much more closely for alternative CNS pathologies. Early spasticity may be related to pathology, demonstrable on NCV/EMG or on biopsy, of peripheral sensory neuropathy that is sending aberrant signals to the CNS and triggering aberrant motor reflexes.

At one time, clinical diagnosis made sense, given there were no disease-modifying drugs. Since, however, there now are, and they are not benign drugs, even if sudden onset appears to warrant some therapy, even with corticosteroids, a final diagnosis needs to rely on more objective methods, the core of which is progressive pathology on neuroimaging. Oligoclonal bands in CSF certainly are suggestive, as well as various HLA abnormalities coexisting with symptoms. Howard C. Berkowitz 11:53, 3 April 2009 (UTC)