Multiple sclerosis – a review

Abstract

Multiple sclerosis (MS) is the commonest non‐traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of disease. The underlying cause of MS, and mechanisms behind this increase remain opaque, although complex gene‐environment interactions almost certainly play a significant role. The epidemiology of MS indicates that low vitamin D, smoking, childhood obesity and infection with the Epstein‐Barr virus are likely to play a role in disease development. Changes in diagnostic methods and criteria mean that we can diagnose people with MS increasingly earlier in their disease trajectory. Alongside this, treatments for MS have increased exponentially in number, efficacy, and risk. We now face a situation where we have the potential to diagnose “pre‐symptomatic MS”, and potentially investigate preventive strategies for this disease. In this comprehensive review, we discuss MS epidemiology, potential aetiological factors and pathology, before moving on to clinical aspects of MS diagnosis and management.