 My name is Heidi Beaton and I'm a neurologist based in Sydney. I'm delighted to provide a brief overview on multiple sclerosis or MS as we call it. I'll cover MS presentation, diagnosis, investigations, treatment and also management. Multiple sclerosis is a chronic autoimmune disease of the central nervous system. Autoimmune diseases are conditions in which the body's own immune system attacks itself. The central nervous system consists of the brain, spinal cord and optic nerves, which are the nerves behind the eyes. MS is both an inflammatory and neurodegenerative condition and is characterized by both demyelination and axonal pathology. Demyelination is the loss of the protective covering that surrounds the part of the nerve cells called axons, which carry electrical impulses along the nerve. Axonal pathology is the damage and or destruction of the axons themselves. MS is the most common cause of neurological disability in young adults. There are approximately 25,600 Australians currently living with MS. The age of onset or age of symptom onset, I should say, is usually between 20 and 40 years of age and there was a female predominance in Australia with three in every four MS cases being female. While the exact cause of MS remains unknown, both genetic and environmental factors are thought to contribute. Contributory environmental factors may include the latitudinal gradient or temperate climate, the degree of UV light exposure and the age of exposure to certain viruses. Risk factors for developing MS include being female, a family history of MS, being Caucasian, exposure to viral infections such as Epstein bar virus, living in temperate climates, low UV light exposure, low vitamin D levels, other autoimmune conditions and also smoking. A presentation with neurological symptoms is required for diagnosis. The symptoms experienced may vary between individuals and depend on the areas involved such as which areas of the brain, spinal cord and or optic nerves are actually involved in individual patients. Relapses or attacks of neurological symptoms characterize around 85% of MS cases from the outset. This type of MS is referred to as relapsing MS. A gradual worsening of neurological symptoms from the outset without relapses of symptoms characterizes the remaining 10 to 15% of MS cases and is called primary progressive MS. Sensory symptoms, weakness, visual disturbance, poor vision, poor coordination, poor mobility and dizziness are common presenting symptoms of vocal sclerosis. Fatigue, bladder and bowel dysfunction, heat intolerance, memory and concentration difficulty are other important symptoms of MS. There are of course other rarer symptoms that MS can also cause. Multiple sclerosis is currently diagnosed using the 2017 McDonald criteria. Different diagnostic criteria are used for relapsing in progressive forms of the disease. There are both clinical and magnetic resonance imaging or MRI components of the diagnostic criteria. Dissemination or separation in time and space are critical to making an MS diagnosis. Other diseases can meet the criteria for MS and subsequently need to be excluded using other tests. For the clinical diagnostic criteria to be met, the history and examination must be consistent with clinical relapses or progressive neurological worsening. With regards to imaging, characteristic brain and or spinal cord lesions also known as MS plaques on MRI support the diagnosis. Depending on lesion locations and features, the MRI criteria may be met and thus form part of the formal diagnosis. The inclusion of MRI criteria in more recent versions of the diagnostic criteria means that in many circumstances an MS diagnosis can now be made earlier than in the past. As I mentioned earlier, multiple tests can be performed to support an MS diagnosis and importantly to rule out alternative diagnoses. MRI of the brain and spinal cord and sometimes the optic nerves are performed looking for typical MS lesions or features that may suggest another diagnosis. Lumbar punctures are commonly performed and the presence of oligoclonal bands in the cerebral spinal fluid are suggestive of an MS diagnosis. Blood stress looking for alternative diagnoses are performed as part of the work up also. Specialised electrical tests called evoked potentials may support an MS diagnosis. Thorough work up and making the correct diagnosis is important in guiding patient treatment and management as mottles sclerosis is often treated very differently from other potential differential diagnoses. Acute MS relapses may be treated with short-term therapies if symptoms are severe and there is and or there is a reduction in urological function. High-dose steroids usually administered intravenously are the most common acute relapse treatment. Intravenous immunoglobulin or plasma exchange may be used in certain circumstances but are certainly used less frequently. Intravenous immunoglobulin is a blood product and plasma exchange involves removing antibodies from the blood and does involve having an IV cannula or intravenous cannula inserted. These treatments shorten the relapse duration but it is unclear as to the effect that they have on the overall clinical outcome in individual patients. The aim of disease modifying therapies is to minimise or stop future clinical relapses and urological disability and also to improve clinical outcomes of course. These treatments predominantly affect the inflammatory component of disease. The early and effective use of disease modifying therapies is optimal for patient outcomes. There are multiple first-line therapy options in Australia for relapsing onset MS. How well they work and the way that they are administered varies between the different medications. There are different side effect profiles, screening and monitoring requirements for the different treatments. Some DMT suppressed the immune system while others simply immunomodulated instead. Individual patient circumstances dictate which disease modifying therapies may be suitable for them. Symptomatic treatments don't affect the MS disease course and are used purely for symptom control. Stiffness, nerve pain, fatigue, mood and bladder and bowel symptoms can all be managed somewhat by good symptomatic management. Multidisciplinary patient care is important in MS management and consists of neurologists, specialist nurses, allied healthcare professionals and other medical specialists. Research in MS is ongoing in multiple areas including disease causation and prognosis, imaging and therapeutics. Clinical trials in disease modifying, symptomatic, neuroprotective, remyelinating and neuroregenerative therapies are all ongoing and so hopefully there's exciting prospects ahead for the treatment and management of MS patients in the future.