From the Guidelines
Multiple sclerosis (MS) is a chronic autoimmune disease that requires prompt and accurate diagnosis, typically established through MRI imaging and the McDonald criteria, to initiate early treatment with disease-modifying therapies (DMTs) and improve long-term outcomes. Clinical symptoms of MS vary widely but commonly include fatigue, numbness or tingling in limbs, vision problems (optic neuritis), muscle weakness, balance issues, cognitive impairment, and bladder dysfunction 1. The diagnosis of MS requires evidence of CNS lesions disseminated in time and space, which can be established through MRI imaging showing characteristic white matter lesions, cerebrospinal fluid analysis revealing oligoclonal bands, and evoked potential tests to assess nerve conduction 1.
Clinical Symptoms
- Fatigue
- Numbness or tingling in limbs
- Vision problems (optic neuritis)
- Muscle weakness
- Balance issues
- Cognitive impairment
- Bladder dysfunction
Diagnosis and Workup
The McDonald criteria guide diagnosis, requiring objective evidence of at least two separate CNS lesions or one lesion with clear evidence of dissemination in time 1. The 2010 McDonald criteria have substantially improved the diagnostic process in relapsing-remitting MS (RRMS), but they exhibit a number of limitations in primary progressive MS (PPMS). MRI criteria for MS are based on the presence of focal lesions in the white matter of the central nervous system, which are considered typical for this condition in terms of distribution, morphology, evolution, and signal abnormalities on conventional MRI sequences 1.
Treatment
Treatment includes disease-modifying therapies (DMTs) such as interferon beta, glatiramer acetate, oral medications like fingolimod, dimethyl fumarate, and teriflunomide, and monoclonal antibodies such as natalizumab and ocrelizumab 1. Acute relapses are treated with high-dose corticosteroids, typically methylprednisolone 1000mg IV daily for 3-5 days. Symptomatic management includes baclofen or tizanidine for spasticity, amantadine for fatigue, and medications for neuropathic pain and bladder dysfunction.
Prognosis
Prognosis varies significantly; relapsing-remitting MS (most common form) may convert to secondary progressive MS over time. Early treatment with DMTs improves long-term outcomes by reducing relapse rates and slowing disability progression. Most patients experience some disability after 10-20 years, but with modern treatments, many maintain good quality of life and function for decades after diagnosis 1.
From the Research
Clinical Symptoms of Multiple Sclerosis
- Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system characterized by inflammatory demyelination with axonal transection 2
- MS typically presents in young adults (mean age of onset, 20-30 years) with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days 2
- The prevalence of MS worldwide ranges from 5 to 300 per 100 000 people and increases at higher latitudes 2
- Overall life expectancy is less than in the general population (75.9 vs 83.4 years), and MS more commonly affects women (female to male sex distribution of nearly 3:1) 2
Diagnosis and Diagnostic Criteria
- Diagnosis is made based on a combination of signs and symptoms, radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions), and laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands), which are components of the 2017 McDonald Criteria 2
- The diagnosis of MS is made on clinicoradiological grounds to prove dissemination of disease in both time and space in the nervous system 3
Workup
- No specific workup is mentioned in the provided studies, but it is implied that a combination of clinical evaluation, radiographic findings, and laboratory tests are used to diagnose MS 2, 3
Treatment
- Nine classes of disease-modifying therapies (DMTs), with varying mechanisms of action and routes of administration, are available for relapsing-remitting MS and secondary progressive MS with activity 2
- These drugs include interferons, glatiramer acetate, teriflunomide, sphingosine 1-phosphate receptor modulators, fumarates, cladribine, and 3 types of monoclonal antibodies 2
- One additional DMT, ocrelizumab, is approved for primary progressive MS 2
- Early initiation of natalizumab produced long-term benefits in relapse outcomes in comparison with BRACETD (interferon beta, glatiramer acetate, teriflunomide, or dimethyl fumarate) 4
- Switching from injectable immunomodulators to fingolimod is associated with fewer relapses, more favorable disability outcomes, and greater treatment persistence compared with switching to another injectable preparation following on-treatment activity of MS 5
Prognosis
- MS is characterized by physical disability, cognitive impairment, and other symptoms that affect quality of life 2
- Treatment with DMT can reduce the annual relapse rate by 29% to 68% compared with placebo or active comparator 2
- The prognosis of MS varies depending on the disease course and response to treatment, but overall life expectancy is less than in the general population 2