Clinical Manifestations

In at least 80 percent of patients, the disease follows a relapsing and remitting course, often in the later stages entering a steadily progressive phase. Fully 5 to 10 percent of patients experience a steadily progressive course from onset. The typical episode of neurological disturbance develops over a matter of days or a week or two, persists for a few weeks, then resolves over a month or two. Common manifestations include reversible episodes of visual loss (optic neuritis), sensory disturbance or weakness in the trunk or limbs, vertigo, and bladder disturbance. Obvious disturbance of intellectual function is uncommon, except in severe cases. Recently, however, subtle defects have been demonstrated early in the course of the disease.

Certain special clinical patterns are of interest. Steadily progressive spastic weakness is more common in late-onset cases (older than 40 years). In Orientals generally, severe and persistent visual loss and limb weakness are particularly common. In the same group, a curious form of spasmodic disorder of the limbs is also frequent. The reasons for these well-documented ethnic differences in the pattern of clinical involvement are unknown.

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