-
Current Opinion in Neurology Jun 2015The increasing availability of effective therapies for multiple sclerosis as well as research demonstrating the benefits of early treatment highlights the importance of... (Review)
Review
PURPOSE OF REVIEW
The increasing availability of effective therapies for multiple sclerosis as well as research demonstrating the benefits of early treatment highlights the importance of expedient and accurate multiple sclerosis diagnosis. This review will discuss the classification, diagnosis, and differential diagnosis of multiple sclerosis.
RECENT FINDINGS
An international panel of multiple sclerosis experts, the MS Phenotype Group, recently revised the multiple sclerosis phenotypic classifications and published their recommendations in 2014. Recent research developments have helped improve the accuracy of multiple sclerosis diagnosis, especially with regard to differentiating multiple sclerosis from neuromyelitis optica spectrum disorders.
SUMMARY
Current multiple sclerosis phenotypic classifications include relapsing-remitting multiple sclerosis, clinically isolated syndrome, radiologically isolated syndrome, primary-progressive multiple sclerosis, and secondary-progressive multiple sclerosis. The McDonald 2010 diagnostic criteria provide formal guidelines for the diagnosis of relapsing-remitting multiple sclerosis and primary-progressive multiple sclerosis. These require demonstration of dissemination in space and time, with consideration given to both clinical findings and imaging data. The criteria also require that there exist no better explanation for the patient's presentation. The clinical history, examination, and MRI should be most consistent with multiple sclerosis, including the presence of features typical for the disease as well as the absence of features that suggest an alternative cause, for a diagnosis of multiple sclerosis to be proposed.
Topics: Diagnosis, Differential; Humans; Multiple Sclerosis
PubMed: 25887774
DOI: 10.1097/WCO.0000000000000206 -
Brain and Behavior Sep 2015Multiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after... (Review)
Review
BACKGROUND
Multiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after head trauma.
DISCUSSION
The etiology of MS is probably multifactorial, related to genetic, environmental, and several other factors. The pathogenesis is not fully understood but is believed to involve T-cell-mediated inflammation directed against myelin and other related proteins with a possible role for B cells. The McDonald criteria have been proposed and revised over the years to guide the diagnosis of MS and are based on clinical presentation and magnetic resonance imaging (MRI) of the brain and spinal cord to establish dissemination in time and space. The treatment of MS includes disease modification with immunomodulator drugs and symptom management to address the specific symptoms such as fatigue, spasticity, and pain.
CONCLUSION
An update on etiology, pathogenesis, diagnosis, and immunomodulatory treatment of MS is presented.
Topics: Brain; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Spinal Cord
PubMed: 26445701
DOI: 10.1002/brb3.362 -
The New England Journal of Medicine Jan 2018
Review
Topics: Antibodies, Monoclonal; Biomarkers; Brain; Glatiramer Acetate; Humans; Immunologic Factors; Interferon-beta; Magnetic Resonance Imaging; Multiple Sclerosis
PubMed: 29320652
DOI: 10.1056/NEJMra1401483 -
Seminars in Neurology Aug 2016It is estimated that there are 300,000 people with multiple sclerosis (MS) in the United States and 2.3 million worldwide. Each MS attack can affect function in... (Review)
Review
It is estimated that there are 300,000 people with multiple sclerosis (MS) in the United States and 2.3 million worldwide. Each MS attack can affect function in cognitive, emotional, motoric, sensory, or visual domains. Patients are often struck in the prime of their lives as they attempt to move forward with career, and family. Since the previous 2010 Seminars in Neurology Pearls and Pitfalls issue, the world of MS has drastically changed and advanced. Here the authors address the ever-changing MS world in both treatment options and diagnostics, covering easily missed differential diagnoses, newly available immunomodulatory therapy, and the challenges of safely treating patients.
Topics: Diagnosis, Differential; Humans; Multiple Sclerosis; United States
PubMed: 27643903
DOI: 10.1055/s-0036-1585456 -
Current Opinion in Neurology Jun 2016We discuss new paradigms for understanding the immunopathology of multiple sclerosis through the recent development of high throughput genetic analysis, emergence of... (Review)
Review
PURPOSE OF REVIEW
We discuss new paradigms for understanding the immunopathology of multiple sclerosis through the recent development of high throughput genetic analysis, emergence of numerous candidate biomarkers, and the broadening of the treatment arsenal.
RECENT FINDINGS
The recent use of genome wide association studies provide new tools for a better understanding of multiple sclerosis etiology. Genome-wide association studies have identified many genes implicated in immune regulation and the next step will be to elucidate how those genetic variations influence immune cell function to drive disease development and progression. Furthermore, patient care has seen the emergence of new biomarkers for monitoring disease progression and response to treatment. Finally, the introduction of numerous immunomodulatory treatments will likely improve clinical outcome of multiple sclerosis patients in the future.
SUMMARY
Breakthroughs in the field of multiple sclerosis have led to a better understanding of the physiopathology of the disease, follow up, and treatment of the patients that develop relapsing remitting multiple sclerosis. The next challenge for multiple sclerosis will be to press forward to model and decipher multiple sclerosis progression, which will help both to develop therapeutics and generate knowledge about mechanisms of neurodegeneration.
Topics: Biomarkers; Disease Progression; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Immunologic Factors; Multiple Sclerosis
PubMed: 27058221
DOI: 10.1097/WCO.0000000000000319 -
Multiple Sclerosis and Related Disorders May 2019Multiple sclerosis (MS) is the most prevalent chronic inflammatory disease of the central nervous system (CNS), affecting more than 2 million people worldwide. It is... (Review)
Review
Multiple sclerosis (MS) is the most prevalent chronic inflammatory disease of the central nervous system (CNS), affecting more than 2 million people worldwide. It is characterized by brain and spinal cord involvement. There are the relapsing remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS) phenotypes. There is a subgroup of RRMS patients who have a more aggressive disease course marked by a rapid accumulation of physical and cognitive deficit, despite treatment with 1 or more disease modifying drugs (DMTs). In the past, this disease phenotype was called "aggressive" MS (AMS); it is now called highly active MS (HAMS). It is generally agreed that the severe nature of this phenotype requires different treatment decisions. Unfortunately, there is no consensus on the definition of AMS or the treatment algorithm. In this article we review HAMS in relation to its definition and the treatments available.
Topics: Central Nervous System; Humans; Multiple Sclerosis
PubMed: 30822617
DOI: 10.1016/j.msard.2019.01.039 -
JAMA Nov 2022
Topics: Humans; Multiple Sclerosis
PubMed: 36413229
DOI: 10.1001/jama.2022.14236 -
Continuum (Minneapolis, Minn.) Aug 2022This article provides an update on progressive forms of multiple sclerosis (MS) commonly referred to as primary progressive MS and secondary progressive MS. It discusses... (Review)
Review
PURPOSE OF REVIEW
This article provides an update on progressive forms of multiple sclerosis (MS) commonly referred to as primary progressive MS and secondary progressive MS. It discusses the importance of diagnosing and detecting progression early, the similarities between progressive forms, challenges in detecting progression, factors that could augment progression, and the importance of disease-modifying therapies in patients with evidence of active progressive MS. It also discusses the overall care of progressive MS.
RECENT FINDINGS
The pathogenesis of primary progressive MS and secondary progressive MS is overlapping, and in both presentations, patients with relapses or focal MRI activity are classified as having active, progressive MS. All currently approved disease-modifying therapies are indicated for active secondary progressive MS. The therapeutic opportunity of anti-inflammatory drugs for the treatment of progressive MS is enhanced in those who are younger and have a shorter disease duration. Vascular comorbidities may contribute to progression in MS.
SUMMARY
Several challenges remain in the diagnosis, follow-up, and treatment of progressive MS. Early identification of active progressive MS is needed to maximize treatment benefit. The advantages of optimal comorbidity management (eg, hypertension, hyperlipidemia) in delaying progression are uncertain. Clinical care guidelines for advanced, severe MS are lacking.
Topics: Disease Progression; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Multiple Sclerosis, Chronic Progressive; Recurrence; Time Factors
PubMed: 35938658
DOI: 10.1212/CON.0000000000001157 -
Medicine Feb 2024Multiple sclerosis (MS) is a chronic autoimmune disease with demyelination, inflammation, neuronal loss, and gliosis (scarring). Our object to review MS pathophysiology... (Review)
Review
Multiple sclerosis (MS) is a chronic autoimmune disease with demyelination, inflammation, neuronal loss, and gliosis (scarring). Our object to review MS pathophysiology causes and treatment. A Narrative Review article was conducted by searching on Google scholar, PubMed, Research Gate about relevant keywords we exclude any unique cases and case reports. The destruction of myelinated axons in the central nervous system reserves this brunt. This destruction is generated by immunogenic T cells that produce cytokines, copying a proinflammatory T helper cells1-mediated response. Autoreactive cluster of differentiation 4 + cells, particularly the T helper cells1 subtype, are activated outside the system after viral infections. T-helper cells (cluster of differentiation 4+) are the leading initiators of MS myelin destruction. The treatment plan for individuals with MS includes managing acute episodes, using disease-modifying agents to decrease MS biological function of MS, and providing symptom relief. Management of spasticity requires physiotherapy, prescription of initial drugs such as baclofen or gabapentin, secondary drug options such as tizanidine or dantrolene, and third-line treatment such as benzodiazepines. To treat urinary incontinence some options include anticholinergic medications such as oxybutynin hydrochloride, tricyclic antidepressants (such as amitriptyline), and intermittent self-catheterization. When it comes to bowel problems, one can try to implement stool softeners and consume a high roughage diet. The review takes about MS causes Pathophysiology and examines current treatment strategies, emphasizing the advancements in disease-modifying therapies and symptomatic treatments. This comprehensive analysis enhances the understanding of MS and underscores the ongoing need for research to develop more effective treatments.
Topics: Humans; Multiple Sclerosis; Treatment Outcome; Chronic Disease; Muscle Spasticity
PubMed: 38394496
DOI: 10.1097/MD.0000000000037297 -
Brain : a Journal of Neurology Mar 2017During the past decades, better understanding of relapsing-remitting multiple sclerosis disease mechanisms have led to the development of several disease-modifying... (Review)
Review
During the past decades, better understanding of relapsing-remitting multiple sclerosis disease mechanisms have led to the development of several disease-modifying therapies, reducing relapse rates and severity, through immune system modulation or suppression. In contrast, current therapeutic options for progressive multiple sclerosis remain comparatively disappointing and challenging. One possible explanation is a lack of understanding of pathogenic mechanisms driving progressive multiple sclerosis. Furthermore, diagnosis is usually retrospective, based on history of gradual neurological worsening with or without occasional relapses, minor remissions or plateaus. In addition, imaging methods as well as biomarkers are not well established. Magnetic resonance imaging studies in progressive multiple sclerosis show decreased blood-brain barrier permeability, probably reflecting compartmentalization of inflammation behind a relatively intact blood-brain barrier. Interestingly, a spectrum of inflammatory cell types infiltrates the leptomeninges during subpial cortical demyelination. Indeed, recent magnetic resonance imaging studies show leptomeningeal contrast enhancement in subjects with progressive multiple sclerosis, possibly representing an in vivo marker of inflammation associated to subpial demyelination. Treatments for progressive disease depend on underlying mechanisms causing central nervous system damage. Immunity sheltered behind an intact blood-brain barrier, energy failure, and membrane channel dysfunction may be key processes in progressive disease. Interfering with these mechanisms may provide neuroprotection and prevent disability progression, while potentially restoring activity and conduction along damaged axons by repairing myelin. Although most previous clinical trials in progressive multiple sclerosis have yielded disappointing results, important lessons have been learnt, improving the design of novel ones. This review discusses mechanisms involved in progressive multiple sclerosis, correlations between histopathology and magnetic resonance imaging studies, along with possible new therapeutic approaches.
Topics: Disease Progression; Humans; Magnetic Resonance Imaging; Multiple Sclerosis
PubMed: 27794524
DOI: 10.1093/brain/aww258