Multiple Sclerosis Questions & Answers

Updated: May 23, 2019
  • Author: Christopher Luzzio, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Questions & Answers

Overview

What is multiple sclerosis (MS)?

What are the signs and symptoms of multiple sclerosis (MS)?

How is multiple sclerosis (MS) diagnosed, and which tests are used?

What are the different types of multiple sclerosis (MS)?

What are the main aspects of treatment of multiple sclerosis (MS)?

What treatments are available for acute relapses of multiple sclerosis (MS)?

Which disease-modifying agents for multiple sclerosis (MS) (DMAMS) have been FDA-approved for use?

Which agents are used in the treatment of aggressive multiple sclerosis (MS)?

Which medications are used to treat the symptoms of multiple sclerosis (MS)?

What is multiple sclerosis (MS)?

What is the etiology of multiple sclerosis (MS)?

How is multiple sclerosis (MS) diagnosed?

Is any attack of CNS demyelination diagnostic for multiple sclerosis (MS)?

What treatments are available for multiple sclerosis (MS)?

What is revealed in the exam of the demyelinating lesions in the spinal cord and brain of patients with multiple sclerosis (MS)?

What is myelocortical multiple sclerosis (MCMS)?

How does the location of multiple sclerosis (MS) lesions affect how the disease manifests?

How are lesions formed in multiple sclerosis (MS)?

What do molecular studies of white matter plaque tissue reveal in multiple sclerosis (MS)?

What is the role of T-lymphocytes in the pathophysiology of multiple sclerosis (MS)?

In addition to T cells, what other immune cells are involved in the pathogenesis of multiple sclerosis (MS)?

What is spinal multiple sclerosis (MS)?

What is optic neuritis (ON) in multiple sclerosis (MS)?

What causes multiple sclerosis (MS)?

What is the role of genetics in multiple sclerosis (MS)?

What is the molecular mimicry hypothesis in multiple sclerosis (MS)?

What is the role of viral illness in multiple sclerosis (MS)?

What is the role of geography in the etiology of multiple sclerosis (MS)?

What is the role of vitamin D in the etiology of multiple sclerosis (MS)?

What is the chronic cerebrospinal venous insufficiency (CCSVI) hypothesis in the etiology of multiple sclerosis (MS)?

Should patients with multiple sclerosis (MS) get a hepatitis B vaccination?

What is the prevalence of multiple sclerosis (MS) in the US, and which patient populations are most commonly affected?

What is the worldwide prevalence of multiple sclerosis (MS), and what is the role of ethnicity in MS?

What is the prognosis of multiple sclerosis (MS)?

What is the life expectancy of patients with multiple sclerosis (MS)?

What educational information should be provided to patients with multiple sclerosis (MS) and their caregivers?

What information resources are available for patients with multiple sclerosis (MS)?

Presentation

What is the significance of optic neuritis (ON) in multiple sclerosis (MS)?

How is spasticity characterized in multiple sclerosis (MS)?

How is constipation characterized in multiple sclerosis (MS)?

How are attacks or exacerbations of multiple sclerosis (MS) characterized?

How does multiple sclerosis (MS) present?

What are the classic symptoms of multiple sclerosis (MS)?

What are uncommon signs and symptoms of multiple sclerosis (MS)?

What are the indications of acute transverse myelitis in patients with multiple sclerosis (MS)?

What is the role of fatigue in multiple sclerosis (MS)?

How is cognitive dysfunction characterized in multiple sclerosis (MS)?

How is pain characterized in multiple sclerosis (MS)?

How is bladder dysfunction characterized in multiple sclerosis (MS)?

How is heat intolerance characterized in multiple sclerosis (MS)?

Which body systems are evaluated in the physical exam of multiple sclerosis (MS)?

Which clinical findings are consistent with multiple sclerosis (MS)?

How does optic neuritis (ON) manifest in multiple sclerosis (MS)?

How is the loss of visual acuity characterized in optic neuritis (ON) in the setting of multiple sclerosis (MS)?

How is demyelinating optic neuritis (ON) characterized in multiple sclerosis (MS)?

What visual changes are associated with optic neuritis (ON) in patients with multiple sclerosis (MS)?

In addition to optic neuritis (ON) what other visual disorders are associated with multiple sclerosis (MS)?

Which disability scale is most commonly used to rate the status of a patient with multiple sclerosis (MS)?

Which neurologic systems are evaluated in the Kurtzke Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS)?

How are the grades of the 10-point Kurtzke Expanded Disability Status Scale (EDSS) defined in multiple sclerosis (MS)?

What are the advantages and limitations of the 10-point Kurtzke Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS)?

What scales other than the Kurtzke Expanded Disability Status Scale (EDSS) can be used to rate the disability of a patient with multiple sclerosis (MS)?

What are the categories of multiple sclerosis (MS)?

How is relapsing-remitting multiple sclerosis (MS) (RRMS) characterized?

How is the progression of relapsing-remitting multiple sclerosis (MS) (RRMS) characterized?

What is the role of disease-modifying agents in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

How are primary progressive multiple sclerosis (MS) (PPMS) and progressive-relapsing multiple sclerosis (PRMS) characterized?

DDX

How is acute disseminated encephalomyelitis (ADEM) distinguished from multiple sclerosis (MS)?

How is Schilder disease distinguished from multiple sclerosis (MS)?

How is Bal concentric sclerosis distinguished from multiple sclerosis (MS)?

How is sarcoidosis distinguished from multiple sclerosis (MS)?

What is CADASIL, and how is it distinguished from multiple sclerosis (MS)?

How is infarction of the spinal cord distinguished from multiple sclerosis (MS)?

How is an arteriovenous fistula distinguished from multiple sclerosis (MS)?

Is CNS demyelination diagnostic for multiple sclerosis (MS)?

What is a common challenge in diagnosing multiple sclerosis (MS)?

What are the main differential diagnoses for multiple sclerosis (MS)?

How are spinal cord neoplasms distinguished from multiple sclerosis (MS)?

How is transverse myelitis distinguished from multiple sclerosis (MS)?

How are vasculitic processes distinguished from multiple sclerosis (MS)?

How is radiation myelitis distinguished from multiple sclerosis (MS)?

What are the differential diagnoses for Multiple Sclerosis?

Workup

How is multiple sclerosis (MS) diagnosed?

Why is early diagnosis of multiple sclerosis (MS) important?

What are the McDonald criteria for a diagnosis of multiple sclerosis (MS)?

Which conditions should be excluded by blood tests in suspected multiple sclerosis (MS)?

Which imaging procedure is used to confirm and monitor multiple sclerosis (MS)?

What are the current guidelines for the use of MRI in the workup of multiple sclerosis (MS)?

What are the advantages of MRI over CT scanning and clinical exam in multiple sclerosis (MS)?

What do MRI results reveal in multiple sclerosis (MS)?

What are the limitations of using MRI in multiple sclerosis (MS)?

What is the role of functional MRI (fMRI) in multiple sclerosis (MS)?

What is the role of magnetic resonance spectroscopy in multiple sclerosis (MS)?

What are the roles of radiography, angiography, and ultrasonography in the investigation of multiple sclerosis (MS)?

Which evoked potential tests are useful in the evaluation of multiple sclerosis (MS)?

What is the role of EEG in the evaluation of multiple sclerosis (MS)?

What is the role of LP in the workup of multiple sclerosis (MS)?

Treatment

What are the 2 main approaches to treatment for multiple sclerosis (MS)?

What is the role of clinically isolated syndrome (CIS) in multiple sclerosis (MS)?

What is the treatment for clinically isolated syndrome (CIS), and what are the implications for the development of multiple sclerosis (MS)?

What are the goals of emergency medical care in cases of acute exacerbation of multiple sclerosis (MS)?

What is the role of plasmapheresis in the emergent treatment of acute fulminant multiple sclerosis (MS)?

How can known precipitants of multiple sclerosis (MS) exacerbation be managed in the emergent setting?

What are the preoperative considerations for emergency surgery in fulminant multiple sclerosis (MS)?

What treatments are available for acute relapses of multiple sclerosis (MS)?

What have the DECIDE and SELECT studies shown about the effectiveness of daclizumab (Zinbryta) in the treatment of relapsing multiple sclerosis (MS)?

Which DMAMS have been approved to treat in multiple sclerosis (MS)?

How are DMAMS administered in the treatment of multiple sclerosis (MS)?

What factors should be considered when choosing a DMAMS for multiple sclerosis (MS)?

What is the role of interferon beta-1b (Betaseron, Extavia) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

How effective is interferon beta-1b (Betaseron, Extavia) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

How is interferon beta-1b (Betaseron, Extavia) administered in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS), and what are the potential adverse reactions?

How effective is interferon beta-1a (Avonex or Rebif) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is the safety and efficacy of high-dose interferon beta-1a (Rebif) in relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is the effect of switching to a higher dosage of interferon beta-1a (Avonex or Rebif) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is peginterferon beta-1a (Plegridy), and how is it administered in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What are the findings of the ADVANCE trial on the use of peginterferon beta-1a (Plegridy) to treat relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is the role of glatiramer acetate (Copaxone) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

How effective is glatiramer acetate (Copaxone) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is the dosage regimen for glatiramer acetate (Copaxone) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is natalizumab (Tysabri), and when is it indicated in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

How effective is natalizumab (Tysabri) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS), and what is its dosage regimen?

What risk factors are associated with natalizumab (Tysabri) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS), and how is its use restricted by the FDA?

Does natalizumab (Tysabri) improve ambulation in relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is fingolimod (Gilenya), and what is the recommended dosage in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is the mechanism of action of fingolimod (Gilenya) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What adverse effects are associated with the use of fingolimod (Gilenya), and what are the FDA recommendations for first-dose monitoring?

When is fingolimod (Gilenya) contraindicated in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What are the recommendations for the use of fingolimod (Gilenya) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS) with preexisting cardiovascular conditions?

Can fingolimod (Gilenya) be used to treat relapsing-remitting multiple sclerosis (MS) (RRMS) in patients who are also on cardiac medications?

What adverse reactions are associated with fingolimod (Gilenya) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is the protocol for switching from natalizumab to fingolimod (Gilenya) in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What is teriflunomide (Aubagio), and how is it administered in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What has the TEMSO trial demonstrated on the use of teriflunomide (Aubagio) to treat relapsing-remitting multiple sclerosis (MS) (RRMS)?

What are the most common adverse reactions associated with teriflunomide (Aubagio), and how are the risks of infection and hypertension mitigated?

When is teriflunomide (Aubagio) contraindicated in the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

Is teriflunomide (Aubagio) safe to use during pregnancy for the treatment of relapsing-remitting multiple sclerosis (MS) (RRMS)?

What adverse effects are associated with the use of teriflunomide (Aubagio) in the treatment of relapsing multiple sclerosis (MS)?

Can teriflunomide (Aubagio) and interferon beta-1a be used together for the treatment of relapsing multiple sclerosis (MS)?

What is dimethyl fumarate (DMF), and how does it work to treat multiple sclerosis (MS)?

What have the DEFINE, CONFIRM, and ENDORSE studies shown about the effectiveness of dimethyl fumarate (DMF) in the treatment of relapsing multiple sclerosis (MS)?

What is alemtuzumab (Lemtrada), and when is it indicated in the treatment of relapsing multiple sclerosis (MS)?

How effective is alemtuzumab (Lemtrada) in the treatment of relapsing multiple sclerosis (MS)?

What have the OPERA studies shown about the effectiveness of ocrelizumab (Ocrevus) in the treatment of relapsing multiple sclerosis (MS)?

When is high-dose cyclophosphamide (Cytoxan) indicated in the treatment of aggressive multiple sclerosis (MS)?

When is mitoxantrone indicated in the treatment of multiple sclerosis (MS)?

What risks are associated with the use of mitoxantrone in the treatment of multiple sclerosis (MS)?

What treatments are available for primary progressive multiple sclerosis (MS) (PPMS), and how effective are they?

Is interferon beta effective in reducing disability progression in primary progressive multiple sclerosis (MS) (PPMS)?

What treatments are available for secondary progressive multiple sclerosis (MS) (SPMS)?

What experimental agents are currently in development for the treatment of multiple sclerosis (MS), and what are the adverse effects?

Is autologous hematopoietic stem cell transplantation (AHSCT) a safe and effective treatment for multiple sclerosis (MS)?

What is the effect of pregnancy and breastfeeding on the course of multiple sclerosis (MS)?

Should treatment of multiple sclerosis (MS) be modified in patients who are pregnant or are planning to become pregnant?

Which symptoms of multiple sclerosis (MS) can be treated?

When does diarrhea occur in patients with multiple sclerosis (MS), and how is it treated?

How is cognitive dysfunction treated in patients with multiple sclerosis (MS)?

How is depression treated in patients with multiple sclerosis (MS)?

How is fatigue treated in patients with multiple sclerosis (MS)?

Which nonpharmacological treatments for fatigue are available for patients with multiple sclerosis (MS)?

Which multiple sclerosis (MS) medications contribute to fatigue?

Is pain a symptom of multiple sclerosis (MS)?

What types of pain are associated with multiple sclerosis (MS), and how are they managed?

What steps can be taken to manage heat intolerance associated with multiple sclerosis (MS)?

When is treatment of spasticity indicated in patients with multiple sclerosis (MS)?

What medications are available to manage spasticity in patients with multiple sclerosis (MS)?

Which medications are used to treat spasticity in multiple sclerosis (MS), and what are the standard dosages and side effects?

Which medication is used to improve walking ability in patients with multiple sclerosis (MS), and how effective is it?

What risks are associated with the use of dalfampridine (Ampyra) in the treatment of multiple sclerosis (MS)?

How is bladder dysfunction managed in multiple sclerosis (MS)?

What are the symptoms of bladder dysfunction in multiple sclerosis (MS), and how are they treated?

What studies are indicated if initial attempts at symptom management for bladder dysfunction in multiple sclerosis (MS) are not effective?

What is the most common bowel problem in multiple sclerosis (MS), and how is it managed?

Which medications are used to manage constipation in multiple sclerosis (MS)?

What are the nonpharmacologic treatments for managing constipation in multiple sclerosis (MS)?

How is sexual dysfunction characterized in multiple sclerosis (MS), and how is it treated?

Which medications can be used to manage tremor in multiple sclerosis (MS), and how effective are they?

Which medications are used to treat optic neuritis in multiple sclerosis (MS), and how effective are they?

Which kinds of therapists may be beneficial to a rehabilitation program for patients with multiple sclerosis (MS)?

What is the role of physical therapy in the management of multiple sclerosis (MS)?

How is stretching used to treat spasticity in multiple sclerosis (MS)?

What nonpharmacologic treatments can be used to relieve pain in multiple sclerosis (MS)?

What is the role of occupational therapy in the management of multiple sclerosis (MS)?

What are the treatment approaches for cognitive dysfunction in multiple sclerosis (MS)?

Who should participate in patient education programs for multiple sclerosis (MS) management?

What is the role of surgical procedures to alleviate symptoms of multiple sclerosis (MS)?

What is the role of vitamin D in multiple sclerosis (MS), and what are the optimal levels of serum vitamin D?

What is the benefit of early treatment with immunomodulatory drugs in multiple sclerosis (MS)?

What is the Uhthoff phenomenon, what are the symptoms, and how is it resolved in multiple sclerosis (MS)?

How does stress or trauma affect the course of multiple sclerosis (MS)?

What consultations should be considered in multiple sclerosis (MS), and which specialists are most commonly involved in a multidisciplinary approach to MS management?

How can a social worker assist patients with multiple sclerosis (MS)?

Which consultations are indicated when a patient with multiple sclerosis (MS) is considering treatment with a medication with known adverse effects?

What is the recommended follow-up and long-term monitoring of multiple sclerosis (MS)?

Which vaccinations are safe in patients with multiple sclerosis (MS)?

Which vaccines have an unknown safety profile in the setting of multiple sclerosis (MS)?

What are the special considerations for vaccination in multiple sclerosis (MS)?

Guidelines

Which organizations have issued guidelines for the use of imaging in the diagnosis of multiple sclerosis (MS)?

What are the guidelines from the CMSC for imaging studies in the diagnosis and monitoring of clinically isolated syndrome (CIS) or suspected multiple sclerosis (MS)?

When is follow-up brain MRI with gadolinium indicated in established multiple sclerosis (MS), according to CMSC guidelines?

What are the MAGNIMS (Magnetic Resonance Imaging in MS) Network guidelines for the use of MRI in multiple sclerosis (MS)?

What are the MAGNIMS (Magnetic Resonance Imaging in MS) Network guidelines for monitoring established multiple sclerosis (MS)?

Are the European Academy of Neurology (EAN) guidelines similar to CMSC and MAGNIMS guidelines?

What are the guidelines for treatment of multiple sclerosis (MS) with an FDA-approved disease-modifying agent?

What are the guidelines on discontinuing DMAMS in the treatment of multiple sclerosis (MS)?

What are the ECTRIMS and EAN guidelines on disease-modifying therapies (DMAMS) for the treatment of multiple sclerosis (MS)?

Medications

What are the goals of multiple sclerosis (MS) treatment and management?

What are the two categories of drugs approved for use in multiple sclerosis (MS)?

Which medications in the drug class Immunomodulators are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Corticosteroids are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Immunosuppressants are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Sphingosine 1-Phosphate Receptor Modulators are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Dopamine Agonists are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Skeletal Muscle Relaxant are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Neuromuscular Blockers, Botulinum Toxins are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Alpha2-Adrenergic Agonists are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Benzodiazepines are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Stimulants are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Anticonvulsants, Hydantoin are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Selective Serotonin/Norepinephrine Reuptake Inhibitors are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Nonsteroidal Anti-Inflammatory Drugs are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Antispasmodic Agents, Urinary are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Laxatives are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Acetylcholinesterase Inhibitors, Central are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Antidiarrheals are used in the treatment of Multiple Sclerosis?

Which medications in the drug class Potassium Channel Blockers are used in the treatment of Multiple Sclerosis?

Which medications in the drug class are used in the treatment of Multiple Sclerosis?