Multiple sclerosis

Abstract

Introduction: Multiple sclerosis is the most common cause of neurological disability in young adults. Irreversible disability can occur, but life expectancy is generally not affected.

Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: interventions aimed at reducing relapse rates and disability; interventions to improve symptoms during acute relapse; treatments for fatigue; treatments for spasticity; and multidisciplinary care on disability? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results: We found 58 systematic reviews, RCTs, and observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following key interventions: amantadine, azathioprine, behaviour modification, botulinum toxin, corticosteroids, exercise, gabapentin, inpatient or outpatient rehabilitation, interferon beta, intrathecal baclofen, intravenous immunoglobulin, methotrexate, mitoxantrone, modafinil, oral drug treatments, oral glatiramer acetate, parenteral glatiramer acetate, physiotherapy, and plasma exchange.