Multiple sclerosis, a treatable disease

Abstract

This article reviews our current understanding and modern treatment of multiple sclerosis (MS). MS is a disabling condition resulting in devastating social and economic impacts. As MS can affect any part of the central nervous system, the presentation is often diverse; however, there are key features that can be useful in the clinic. We comment on the diagnostic criteria and review the main subtypes of MS, including clinically isolated syndrome, relapsing remitting MS, secondary progressive MS and primary progressive MS. Although the underlying aetiology of MS is still not known, we summarise those with most evidence of association. Finally, we aim to present treatment strategies for managing the acute relapse, disease-modifying therapies and MS symptoms. This review highlights that progressive MS is an area where there is currently a paucity of available disease-modifying treatments and this will be a major focus for future development.

Keywords: Diagnostic criteria; epidemiology; multiple sclerosis; progressive multiple sclerosis; treatments.

Fig 1.

Relapse onset multiple sclerosis leads to the progressive accumulation of disability with neurodegeneration after 10–15 years, with less focal inflammation as highlighted by fewer relapses and MRI T2 lesions or gadolinium-enhancing lesions. MRI = magnetic resonance imaging

Fig 2.

The number of multiple sclerosis disease-modifying ­therapies (DMTs) that have European Medicines Agency (EMA) or US Food and Drug Administration (FDA) approval. DMTs approved in 2016: β-interferon-1a (Avonex), β-interferon-1b (betaferon), glatiramer acetate (Copaxone), mitoxantrone (Novantrone)*, β-interferon-1a (Rebif), ­natalizumab (Tysabri), teriflunomide (Aubagio), alemtuzumab (Lemtrada), fingolimod (Gilenya), dimethyl fumarate (Tecfidera), interferon beta 1b (Extavia), β-interferon-1a (Plegridy). *Mitoxantrone (Novantrone) has FDA approval only.