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Multiple sclerosis

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"multiple sclerosis" AND treatment

Multiple sclerosis (MS) is a broad topic. Here's a breakdown of what it covers, based on the neurology, family medicine, and other textbooks in the library, plus recent Cochrane/systematic review evidence:
Topic map:
  1. Pathophysiology & immunology - autoimmune demyelination, CNS plaque formation, role of T-cells/B-cells
  2. Clinical presentation & subtypes - relapsing-remitting, secondary progressive, primary progressive, primary relapsing; classic symptoms (optic neuritis, Lhermitte's sign, internuclear ophthalmoplegia, fatigue, bladder dysfunction)
  3. Diagnosis - McDonald criteria, MRI findings (periventricular/juxtacortical lesions, Dawson's fingers), CSF oligoclonal bands, evoked potentials
  4. Disease-modifying therapy (DMTs) - interferons, glatiramer acetate, fingolimod, natalizumab, ocrelizumab/rituximab, cladribine, and others
  5. Acute relapse management - IV corticosteroids, plasma exchange
  6. Symptomatic management - spasticity, fatigue, bladder/bowel, pain, depression
  7. Prognosis & special populations - pregnancy, pediatric MS, disease course prediction
Brief overview: MS is a chronic autoimmune demyelinating disease of the CNS characterized by inflammatory plaques disseminated in time and space. It typically presents in young adults (20s-40s), more common in women, with relapsing-remitting course being most common at onset. Diagnosis relies on clinical presentation plus MRI evidence of demyelinating lesions and exclusion of mimics, per the McDonald criteria. Treatment has shifted heavily toward high-efficacy disease-modifying therapies (like ocrelizumab, natalizumab) started early to reduce relapse rate and disability accumulation. Recent Cochrane reviews (2024-2025) have evaluated rituximab (PMID: 40066932) and azathioprine (PMID: 39651635) as DMT options, and a 2025 network meta-analysis looked at treatments for MS-related cognitive dysfunction (PMID: 41127289) - worth flagging since these could refine older textbook guidance on second-line agents.
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