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The Multiple Facets of Multiple Sclerosis

Correspondence: Requests for reprints should be addressed to: Patricia Fagan Jenkins, C.O., 2617C W. Holcombe Blvd. #575, Houston, TX 77025.

Introduction: Multiple sclerosis (MS) is an inflammatory and degenerative entity that may involve the brain, optic nerve, and/or the spinal cord. We reviewed 137 patients, aged 4–54 years old at the time of the diagnosis and will report on the vision, different motility disorders found, visual fields, optic neuritis and RAPD, return of vision following the neuritis, visual evoked potential, nerve fiber layer analysis, and systemic problems such as Uhthoff phenomenon, L'Hermitte sign, urinary urgency, and constipation.

Methods: One hundred thirty-seven patients were given full ophthalmologic and orthoptic evaluations. Particular attention was given to subtle relative afferent pupillary defects (RAPD), oscillopsia, pain with eye movement, and other specialty testing including visual evoked potentials and nerve fiber layer assessment. The immunology, pediatric MS, clinical courses, and treatment are also discussed. Treatment included medication, orthoptic modalities, strabismus procedures, and cooling devices.

Results: Motiltiy disorders included exophoria, unilateral Internuclear Ophthalmoplegia (INO), esophoria, and various types of nystagmus. The majority of nonmotility ophthalmic entities included optic neuritis, RAPD, and abnormal nerve fiber layer studies. Most patients were diagnosed based on white matter lesions on the MRI and oligoclonal bands in the spinal fluid after lumbar puncture. The majority of systemic signs were numbness, Uhthoff sign, and balance difficulties. Thirty-four percent of the patients were helped with either convergence therapy, prisms for all kinds of diplopia, and field manipulation.

Conclusions: MS is a multi-factorial entity. It is important to emphasize how important a few extra history questions are, including: any pain with eye movement, any bouncing of the images, and is vision or balance any worse in the heat? The Visual Evoked Potential (VEP) and nerve fiber layer studies are important in the diagnosis of MS. Seventy percent of patients with had eye complaints as their initial symptom. Finally, one-third of all patients were helped with some form of orthoptic therapy.

Key words: multiple sclerosis (MS), diplopia, INO, optic neuritis, pediatric demyelinating disease