Multiple Sclerosis
Authors: Daniel M. Harrison
Journal: Annals of Internal Medicine (2014)

In the Clinic1 April 2014Multiple SclerosisDaniel M. Harrison, MD, Deborah Cotton, MD, MPH, Jaya K. Rao, MD, MHS, Darren Taichman, MD, PhD, and Sankey Williams, MDDaniel M. Harrison, MD, Deborah Cotton, MD, MPH, Jaya K. Rao, MD, MHS, Darren Taichman, MD, PhD, and Sankey Williams, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-160-7-201404010-01004 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Multiple sclerosis (MS) is an autoimmune condition that results in inflammatory damage to the central nervous system (CNS). The pathologic hallmarks of MS are diffuse and focal areas of inflammation, demyelination, gliosis, and neuronal injury in the optic nerves, brain, and spinal cord. In addition to affecting white matter tracts, MS results in injury to the cortical and deep gray matter. The neurologic symptoms and disability that patients with MS experience are a direct consequence of these pathologic processes, resulting in acute and chronic disruption of white matter tracts and gray matter structures.MS is the most common nontraumatic cause ...References1. Niedziela N, Adamczyk-Sowa M, Pierzchala K. Epidemiology and clinical record of multiple sclerosis in selected countries: a systematic review. Int J Neurosci. 2013. [Epub ahead of print] [PMID: 23998938] Google Scholar2. Islam T, Gauderman WJ, Cozen W, Hamilton AS, Burnett ME, Mack TM. Differential twin concordance for multiple sclerosis by latitude of birthplace. Ann Neurol. 2006;60:56-64. [PMID: 16685699] Google Scholar3. Patsopoulos NA, Barcellos LF, Hintzen RQ, Schaefer C, van Duijn CM, Noble JA, et al; IMSGC. Fine-mapping the genetic association of the major histocompatibility complex in multiple sclerosis: HLA and non-HLA effects. PLoS Genet. 2013;9:e1003926. [PMID: 24278027] Google Scholar4. 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[PMID: 12499473] Google Scholar45. Farez MF, Correale J. Immunizations and risk of multiple sclerosis: systematic review and meta-analysis. J Neurol. 2011;258:1197-206. [PMID: 21431896] Google Scholar Author, Article, and Disclosure InformationAffiliations: CME Objective: To review current evidence for diagnosis and treatment of multiple sclerosis.Funding Source: American College of Physicians.Disclosures: Dr. Harrison, ACP Contributing Author, has disclosed the following conflicts of interest: Personal fees: MedImmune, Questcor; Grants: Bayer Neurosciences, Merck-Serono. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0547.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.With the assistance of additional physician writers, Annals of Internal Medicine editors develop In the Clinic using resources of the American College of Physicians, including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). 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