Multiple sclerosis (MS)
EBM Guidelines
Jan 21, 2022 • Latest change Jan 21, 2022
Table of contents
Extract
- Multiple sclerosis (MS) is an autoimmune disease of unknown aetiology that mainly affects the white matter of the central nervous system (CNS).
- The symptoms of multiple sclerosis are diverse, depending on the location and size of the CNS inflammatory lesions (plaques).
- MS is divided into subtypes: relapsing-remitting, secondary progressive and primary progressive. The relapsing-remitting form is the most common, and it manifests itself as exacerbations (relapses).
- MS is diagnosed on the basis of clinical presentation, cerebrospinal fluid (CSF) examination and magnetic resonance imaging (MRI).
- Pulse glucocorticoid therapy is used to manage acute exacerbations. Several different medications, that can be administered in various ways, are nowadays available for long-term therapy, depending on the activity of the disease.
- No curative therapy exists as yet. Disease progress is individual. On average, the prognosis has clearly improved in the course of the last 20 years, resulting from changes in diagnostic criteria and developments in pharmacotherapy.
Linked evidence summaries
- High dose methylprednisolone appears to accelarate the recovery from multiple sclerosis relapses.B
- Oral and intravenous methylprednisolone may be equally efficient and safe in treatment of relapses in MS patients.C
- Teriflunomide at a dose of 14 mg/day appears to decrease both the number of patients with at least one relapse and the relapse rate in multiple sclerosis over one or two years.B
- Dimethyl fumarate reduces both the number of patients with a relapse and the annualised relapse rate over two years in comparison with placebo in relapsing remitting multiple sclerosis. The efficacy is sustained over 5 years regarding both low relapse rate and MRI activity.A
- Natalizumab reduces the relapse rate and progression of disability in patients with relapsing remitting multiple sclerosis.A
- Alemtuzumab is better than interferon beta-1a for relapse-free survival, sustained disease progression-free survival and MRI lesions at 24 months in multiple sclerosis. However, adverse events are more common for alemtuzumab.A
- Fingolimod reduces inflammatory activity in relapsing multiple sclerosis over 2 years vs. placebo, but it may lead to little difference in preventing disability worsening. The risk of adverse events requires careful monitoring over time. The evidence on the risk/benefit profile of fingolimod vs. i.m. interferon beta-1a is uncertain.A
- Mitoxantrone may be efficient in reducing the risk of progression and the frequency of relapses in patients with relapsing-remitting or secondary progressive multiple sclerosis (MS) in a short-term follow-up (two years).C
- Azathioprine appears to reduce relapses and disability progression in patients with multiple sclerosis.B
- There is insufficient evidence on the efficacy of amantadine in reducing fatigue in people with MS.D
- Cognitive behavioural approaches may be beneficial in helping people to adjust to and cope with having MS and in the treatment of associated depression. Other psychological interventions may also be helpful.C
- Exercise therapy may be a beneficial symptomatic and supportive treatment for multiple sclerosis (MS) patients by improving muscle function and mobility. It may also be moderately effective in the treatment of fatigue in MS without increasing the risk of relapse.C
- Neuropsychological rehabilitation may reduce cognitive symptoms in multiple sclerosis.C
Search terms
Cerebrospinal Fluid, Demyelinating Diseases, F02.89, G35, Glatiramer acetate, HLA-A3 Antigen, HLA-B7 Antigen, HLA-DR2 Antigen, Interferon-beta, Interferons, MS, Magnetic Resonance Imaging, Methylprednisolone, Multiple Sclerosis, Muscle Spasticity, Natalizumab, Neurology, Oligoclonal Bands, Spasticity, evoked potential study, myelin proteins, optic neuritis