What is Multiple Sclerosis (MS)?

From the Guidelines

Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, causing damage to the protective covering of nerve fibers (myelin) and disrupting communication between the brain and body, with diagnosis based on the detection of lesions within the CNS that demonstrate dissemination in space (DIS) and dissemination in time (DIT) 1. The diagnosis of MS is complex and requires a combination of clinical presentation, MRI findings, and exclusion of alternative diagnoses. According to the 2010 McDonald criteria, the diagnosis can be made on the clinical presentation alone, but MRI should be done to support the clinical diagnosis and rule out other disorders 1.

Key Diagnostic Criteria

• Dissemination in space (DIS): detection of lesions within the CNS that demonstrate dissemination in space
• Dissemination in time (DIT): detection of lesions within the CNS that demonstrate dissemination in time
• Exclusion of alternative diagnoses that can mimic MS either clinically or radiologically

MRI Findings

MRI findings can replace certain clinical criteria in a substantial proportion of patients, and the 2010 McDonald MRI criteria have increased the sensitivity of the criteria and simplified the features of both DIS and DIT 1.

Limitations

However, the 2010 McDonald criteria exhibit a number of limitations in primary progressive MS (PPMS), and paraclinical support of the PPMS diagnosis can be based solely on brain and spinal cord MRI findings, but brain MRI features can be normal in patients with PPMS 1.

Importance of Early Diagnosis

Early diagnosis and treatment are crucial as they can significantly slow disease progression and preserve neurological function, and the availability of expensive disease-modifying treatments is growing, and these drugs are thought to be particularly effective in the early phases of the disease 1.

From the Research

Definition of Multiple Sclerosis (MS)

• Multiple sclerosis (MS) is a progressive inflammatory disease of the central nervous system that results in neurological dysfunction and disability 2.
• It is characterized by the initiation of disease-modifying therapy (DMT) early in the course of MS, which may improve the prognosis for patients with MS and reduce the occurrence of neurological damage 2, 3.

Types of MS

• Relapsing-remitting MS (RRMS) is a type of MS where DMT reduces the rate of relapses, reduces the appearance of magnetic resonance imaging markers of disease activity, and slows the course of disability progression 2.
• Clinically isolated syndrome (CIS) is a condition where patients have had 1 attack of neurological symptoms consistent with MS, and the initiation of DMT following this attack has been shown to delay the conversion to clinically definite MS (CDMS) 2.

Treatment of MS

• Disease-modifying therapies (DMTs) are used to treat MS, and early initiation of DMT has been shown to produce long-term benefits in relapse outcomes 3.
• Interferon beta (IFNβ) is a type of DMT that has been used to treat relapsing forms of MS, and has been shown to reduce relapse rates and delays in the onset of disability 4.
• Other treatment options for MS include natalizumab, glatiramer acetate, teriflunomide, and dimethyl fumarate, among others 3, 5, 6.

Importance of Early Treatment

• Early diagnosis and treatment of MS can be hindered by delays in consulting a physician or reluctance to start DMT, which can lead to poor patient outcomes 2.
• Continued adherence to treatment is often poor, and this lack of adherence is associated with poor patient outcomes 2.
• Early initiation of DMT has been shown to be more effective in reducing the risk of relapse and slowing disability progression 2, 3.