Multiple sclerosis (MS) poses a diagnostic challenge in general practice due to its diverse symptoms and elusive nature. In a CPD-accredited webinar sponsored by Activo Health, Dr Dion Opperman illuminates the complexities of MS diagnosis and management.
If you missed this CPD-accredited webinar, go to https://vimeo.com/event/4150833 to view the replay. The webinar is sponsored by Activo Health.
Multiple sclerosis (MS) presents a complex diagnostic challenge in general practice due to its varied and sometimes subtle symptoms.
Dr Dion Opperman, a distinguished authority in the field, sheds light on the intricacies of MS diagnosis and management in a recent CPD-accredited webinar sponsored by Activo Health. MS is a chronic autoimmune disease affecting the central nervous system (CNS), characterised by damage to myelin, axons, and oligodendrocytes. The CNS comprises the brain, brainstem, cerebellum, spinal cord, and optic nerves. Damage to myelin leads to scar tissue formation (sclerosis), disrupting nerve impulse transmission and causing symptoms.
AETIOLOGY AND EPIDEMIOLOGY
While the exact cause remains elusive, factors such as viral infections (eg, Epstein-Barr virus), smoking, and low vitamin D levels are implicated. In South Africa, MS is more prevalent in women, typically onset between ages 16 and 45, and more common in individuals of Northern European descent, though there's a rising incidence among ethnic South Africans.
DIAGNOSTIC CRITERIA AND GP'S ROLE
Diagnosing MS requires a thorough evaluation based on dissemination in time and space, presence of oligoclonal bands, and exclusion of other conditions. General practitioners play a crucial role in early detection by taking detailed histories of present and earlier neurological symptoms, inquiring about fatigue and urinary urgency, and assessing symptom exacerbation in hot conditions.
CLINICAL PRESENTATION AND EXAMINATION
MS presents with diverse sensory symptoms, often with subacute onset. Understanding upper and lower motor neuron signs is essential for accurate diagnosis. Examinations may reveal optic neuritis, spinal cord attacks (eg, MS hug, bladder dysfunction), brainstem involvement (eg, trigeminal neuralgia), cerebellar dysfunction (eg, ataxia, tremor), or cerebral manifestations (eg, cognitive impairment).
IMPORTANCE OF EARLY DIAGNOSIS
Early diagnosis is paramount as MS evolves from an inflammatory to a degenerative phase. Timely intervention during the inflammatory stage is crucial as treatments are more effective, while options for the degenerative phase are limited. Clinical trials now focus on achieving NEDA (No Evidence of Disease Activity) and preventing progressive brain atrophy.
RESOURCES AND SUPPORT
The Multiple Sclerosis South Africa (MSSA) organisation offers invaluable support and education to both patients and healthcare professionals. Their services extend to various disciplines, including doctors, physiotherapists, occupational therapists, biokineticists, and psychologists.
In conclusion, enhancing awareness and understanding of MS among general practitioners is vital for early detection and optimal management, ultimately improving outcomes for patients affected by this complex neurological condition.
For further information and support, visit www.multiplesclerosis.co.za or contact info@multiplesclerosis.co.za.
