What is the diagnosis for Multiple Sclerosis (MS)?

From the Guidelines

Multiple sclerosis (MS) diagnosis should be based on the 2017 revision of the McDonald criteria, which integrates clinical and MRI findings to demonstrate dissemination of lesions in space and time, as recommended by the most recent and highest quality study 1. The diagnosis of MS typically requires evidence of damage in at least two separate areas of the central nervous system (brain, spinal cord, or optic nerves), occurring at different times. MRI is the most important diagnostic tool, showing characteristic lesions or plaques, and cerebrospinal fluid analysis may reveal oligoclonal bands, indicating immune system activity within the central nervous system. Some key points to consider in the diagnosis of MS include:

• The importance of demonstrating dissemination in space and time of lesions typical of MS, as well as the exclusion of other, better explanations for the clinical features 1.
• The use of MRI to support the clinical diagnosis and rule out other disorders, with careful determination of which imaging features and patterns constitute ‘typical’ multiple sclerosis lesions and which are atypical 1.
• The role of cerebrospinal fluid analysis and evoked potential tests in providing additional support for the diagnosis, particularly in situations where the clinical picture is unusual or the imaging criteria for diagnosis are not fulfilled 1.
• The need for a neurologist with expertise in MS to oversee diagnosis and treatment planning, as MS management is complex and individualized based on disease type, severity, and patient factors. Some of the key considerations in the diagnosis of MS include:
• The 2017 revision of the McDonald criteria, which provides a framework for the diagnosis of MS based on clinical and MRI findings 1.
• The importance of careful clinical evaluation and paraclinical testing to exclude other conditions that may mimic MS, and to identify patients who may benefit from disease-modifying therapies 1.
• The need for ongoing monitoring and follow-up to assess disease progression and adjust treatment plans as needed, particularly in patients with unusual or atypical presentations 1.

From the Research

Diagnosis of Multiple Sclerosis

• The diagnosis of multiple sclerosis (MS) is made on clinicoradiological grounds to prove dissemination of disease in both time and space in the nervous system 2
• A multidisciplinary panel developed disease-modifying therapy (DMT) recommendations, integrating findings from a systematic review, and developed modified Delphi consensus-based recommendations concerning starting, switching, and stopping DMTs pertinent to people with relapsing-remitting MS, secondary progressive MS, primary progressive MS, and clinically isolated syndromes of demyelination 3

Disease-Modifying Therapies for Multiple Sclerosis

• Interferon beta (IFNβ) was the first disease-modifying therapy available to treat multiple sclerosis (MS), providing patients with a treatment that resulted in reduced relapse rates and delays in the onset of disability 4
• Four IFNβ drugs are currently approved to treat relapsing forms of MS: subcutaneous (SC) IFNβ-1b, SC IFNβ-1a, intramuscular IFNβ-1a, and, most recently, SC peginterferon beta-1a 4
• Glatiramer acetate (GA) is another disease-modifying therapy used to treat relapsing-remitting multiple sclerosis (RRMS) 5, 6
• The choice of a specific DMT should reflect the risk/benefit profile, as well as the impact on quality of life 5

Comparison of Disease-Modifying Therapies

• A systematic review compared the effectiveness of IFNs-beta and GA on disease course through the analysis of head-to-head trials, and found that both therapies showed similar clinical efficacy at 24 months 5
• However, at 36 months, evidence from a single study suggests that relapse rates were higher in the group given IFNs than in the GA group 5
• Secondary magnetic resonance imaging (MRI) outcomes analysis showed that effects on new or enlarging T2- or new contrast-enhancing T1 lesions at 24 months were similar, but the reduction in T2- and T1-weighted lesion volume was significantly greater in the groups given IFNs than in the GA groups 5

Switching Disease-Modifying Therapies

• Switching among interferon therapies may be a viable option for patients who experience issues with tolerability 4
• Prior IFN-beta-1b treatment does not negatively influence the efficacy, safety, or tolerability of subsequent GA therapy, and switching to GA can benefit patients who discontinue IFN-beta therapy 6