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Anaesthetic management for a patient with severe multiple sclerosis.

Multiple Sclerosis (MS) is a disease of temperate climate. It is rare amongst Asian and African races. Its overall incidence is 0.1-0.4%. MS is primarily a disease of young adults with the onset of symptoms between the ages of 15 and 40 years and often present with a single neurological deficit, usually via a single lesion (55%) in the optic nerve, brain stem and spinal cord. The effect of surgery and anesthesia on the course of MS is controversial. Some reports indicate that symptoms of MS are exacerbated by anesthesia, particularly regional anesthesia. A relatively high proportion of patients with MS who receive spinal anesthesia do have an exacerbation of symptoms after surgery. It was suggested that demyelinated areas of the spinal cord might be more sensitive to the effects of local anesthetics. However, there is no clear evidence that anesthesia, general or regional contributes to an exacerbation of the disease.