Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
Several subtypes, or patterns of progression, have been described.
Subtypes use the past course of the disease in an attempt to predict
the future course. They are important not only for prognosis but
also for treatment decisions. In 1996, the United States National
Multiple Sclerosis Society described four clinical courses:
subtype is characterized by unpredictable relapses followed by
periods of months to years of relative quiet (remission) with no new
signs of disease activity. Deficits that occur during attacks may
either resolve or leave problems, the latter in about 40% of attacks
and being more common the longer a person has had the disease. This
describes the initial course of 80% of individuals with MS. When
deficits always resolve between attacks, this is sometimes referred
to as benign MS, although people will still build up some degree of
disability in the long term. On the other hand, the term malignant
multiple sclerosis is used to describe people with MS having reached
significant level of disability in a short period of time. The
relapsing-remitting subtype usually begins with a clinically
isolated syndrome (CIS). In CIS, a person has an attack suggestive
of demyelination, but does not fulfill the criteria for multiple
sclerosis. 30 to 70% of persons experiencing CIS later develop MS.
Secondary progressive MS occurs in around 65% of those with initial
relapsing-remitting MS, who eventually have progressive neurologic
decline between acute attacks without any definite periods of
remission. Occasional relapses and minor remissions may appear. The
most common length of time between disease onset and conversion from
relapsing-remitting to secondary progressive MS is 19 years.
The primary progressive subtype occurs in
approximately 10–20% of individuals, with no remission after the
initial symptoms. It is characterized by progression of disability
from onset, with no, or only occasional and minor, remissions and
improvements. The usual age of onset for the primary progressive
subtype is later than of the relapsing-remitting subtype. It is
similar to the age that secondary progressive usually begins in
relapsing-remitting MS, around 40 years of age.
Progressive relapsing MS describes those individuals who, from
onset, have a steady neurologic decline but also have clear
superimposed attacks. This is the least common of all subtypes.
Unusual types of MS have been described; these include Devic's
disease, Balo concentric sclerosis, Schilder's diffuse sclerosis,
and Marburg multiple sclerosis. There is debate on whether they are
MS variants or different diseases. Multiple sclerosis behaves
differently in children, taking more time to reach the progressive
stage. Nevertheless, they still reach it at a lower average age than
adults usually do.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .