{ "schemaVersion": 2, "eyebrow": "Neurology", "title": "Multiple Sclerosis", "summary": "Diagnose multiple sclerosis by demonstrating typical dissemination and excluding mimics, treat clinically meaningful relapses promptly, and initiate disease-modifying therapy early while matching efficacy, safety, reproductive plans, and inflammatory activity.", "seoDescription": "Physician guide to multiple sclerosis diagnosis, relapse management, disease-modifying therapy selection, pregnancy considerations, and monitoring.", "clinicalQuestion": "How should clinicians confirm multiple sclerosis, manage relapses, and select disease-modifying therapy across relapsing and progressive phenotypes?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "multiple sclerosis diagnosis", "McDonald criteria", "MS relapse", "disease-modifying therapy", "ocrelizumab", "MS pregnancy" ], "keyTakeaways": [ "Apply McDonald criteria only after confirming a compatible clinical syndrome and excluding alternative inflammatory, infectious, vascular, structural, and metabolic explanations; CSF oligoclonal bands are supportive but not MS-specific. [1][16][23]", "Use MRI of the brain and spinal cord to document typical lesions and support dissemination in space and time; CSF, OCT, and visual evoked potentials are adjuncts when diagnostic uncertainty remains. [2][16][23]", "Treat a disabling relapse after excluding infection with intravenous methylprednisolone; consider plasma exchange for a severe corticosteroid-refractory relapse. [5][6]", "Start a disease-modifying therapy early for inflammatory MS and reassess for clinical or MRI inflammatory activity, because treatment aims to reduce relapses and slow disability accumulation. [19][23]", "For highly active relapsing disease, select higher-efficacy therapy when the anticipated benefit outweighs infection, malignancy, reproductive, and monitoring burdens; ocrelizumab is used for relapsing MS and is the approved disease-modifying option for primary progressive MS. [12][22]", "Discuss pregnancy plans before selecting or stopping a disease-modifying therapy; routine preconception or immediate postconception discontinuation can increase relapse risk in patients with highly active disease. [5][6]" ], "sections": [ { "id": "diagnostic-confirmation", "eyebrow": "Diagnosis", "heading": "Confirm MS only after defining the clinical syndrome and excluding mimics", "intro": "MRI and CSF findings support, but do not independently establish, the diagnosis.", "paragraphs": [ "Anchor the workup to a clinically compatible central nervous system demyelinating syndrome, then use clinical and paraclinical evidence to demonstrate dissemination in space and time while excluding a better explanation. The 2024 McDonald revisions incorporate MRI and CSF biomarkers within a unified diagnostic approach, but the diagnostic framework still requires integration with the clinical presentation and competing diagnoses. [2][16]", "Obtain MRI to identify lesions in the brain and spinal cord that support MS. When the initial MRI and clinical history do not establish dissemination, use interval MRI and CSF analysis to resolve uncertainty rather than assigning MS from nonspecific symptoms or a single lesion pattern. MRI, lumbar puncture, OCT, and visual evoked potentials can each provide supportive evidence, but none substitutes for exclusion of clinically plausible alternatives. [2][16][23]", "Interpret CSF oligoclonal IgG bands or an elevated IgG index as intrathecal immune activity that can support MS in the appropriate clinical-MRI context. Do not treat oligoclonal bands as disease-specific: they can occur outside MS and should be weighed against the overall CSF profile, MRI phenotype, and clinical red flags. [1][3]" ], "bullets": [ "Use a targeted differential workup when the phenotype, MRI distribution, or CSF profile is atypical rather than applying broad untargeted testing. [16]", "Escalate diagnostic review when a competing disease explains the presentation more completely; MS remains a diagnosis requiring exclusion of alternative causes. [16][23]" ], "subsections": [], "table": { "caption": "Tests that refine diagnostic certainty in suspected multiple sclerosis. [2][3][16][23]", "columns": [ "Test", "Decision contribution", "Interpretive limitation" ], "rows": [ [ "Brain and spinal cord MRI", "Identifies plaques and supports dissemination in space and time. [2][16][23]", "Interpret in the clinical context and assess for imaging patterns suggesting an alternative disorder. [16]" ], [ "CSF oligoclonal IgG bands or IgG index", "Supports intrathecal immune activity and may support the MS diagnosis. [1][3]", "Oligoclonal bands are not specific for MS. [1]" ], [ "Optical coherence tomography", "Provides supportive evidence of optic pathway involvement when clinically relevant. [23]", "Adjunctive; does not independently establish MS. [23]" ], [ "Visual evoked potentials", "Can support evidence of optic pathway dysfunction. [23]", "Adjunctive; correlate with symptoms, examination, and MRI. [23]" ] ] } }, { "id": "acute-relapse-management", "eyebrow": "Acute care", "heading": "Treat disabling relapses after excluding pseudo-relapse and infection", "intro": "Relapse treatment targets functional recovery; it does not replace disease-modifying therapy.", "paragraphs": [ "Before corticosteroids, determine whether new neurologic worsening is better explained by infection or another reversible trigger. In pregnancy-specific guidance, urinary tract infection is explicitly identified as an infection to exclude before treating a disabling relapse; the same diagnostic discipline avoids treating infection-associated symptom recrudescence as active inflammatory relapse. [5][6]", "For a disabling relapse, administer intravenous methylprednisolone at the recommended MS relapse dose. During pregnancy, this treatment is recommended regardless of trimester after infection has been excluded, and it can also be given while breastfeeding. [5][6]", "For a very severe relapse that fails to respond to corticosteroids, consider plasma exchange. This escalation is reserved for corticosteroid-refractory, severe deficits rather than routine relapse care. [5][6]" ], "bullets": [ "Use rehabilitation interventions when residual deficits impair function; rehabilitation can improve functioning and quality of life and reduce stiffness and spasticity. [23]", "Separate acute relapse treatment from chronic symptom treatment: agents used for fatigue, spasticity, depression, urinary dysfunction, or sexual dysfunction may improve symptoms but do not alter the disease course. [23]" ], "subsections": [], "table": { "caption": "Action pathway for new neurologic worsening in established MS. [5][6][23]", "columns": [ "Clinical branch", "Immediate action", "Next step" ], "rows": [ [ "New deficit with suspected infection or other trigger", "Evaluate and treat the trigger before labeling the event an inflammatory relapse. [5][6]", "Reassess neurologic deficits after the reversible cause is addressed. [5][6]" ], [ "Disabling inflammatory relapse", "Administer intravenous methylprednisolone after infection is excluded. [5][6]", "Assess functional recovery and review whether maintenance therapy is adequately suppressing inflammatory activity. [19][23]" ], [ "Very severe relapse without adequate corticosteroid response", "Consider plasma exchange. [5][6]", "Coordinate escalation through an MS-experienced neurologic team. [5][6]" ] ] } }, { "id": "disease-modifying-therapy", "eyebrow": "Long-term management", "heading": "Select disease-modifying therapy by inflammatory activity, phenotype, and treatment risk", "intro": "Disease-modifying therapy reduces inflammatory activity but does not eliminate progression in every patient.", "paragraphs": [ "Initiate disease-modifying therapy as early as possible in MS to reduce relapse frequency and severity and to slow disease progression. In relapsing disease, current treatment strategy emphasizes early and complete suppression of inflammatory activity, reflected by relapses and new MRI activity. [19][23]", "For relapsing MS, choose between escalation from lower-risk therapies and early use of higher-efficacy therapy according to disease activity, prognostic concern, prior treatment response, comorbidity, and the patient’s tolerance for serious adverse effects and monitoring. More effective therapies can carry more serious safety liabilities, so treatment selection is a benefit-risk decision rather than a uniform sequence. [7][22]", "Ocrelizumab is a potent CD20-directed B-cell-depleting immunotherapy used in relapsing MS and primary progressive MS. It is used as a second-line option when first-line treatment is insufficient and may be used first line in highly active disease; it remains the approved disease-modifying option for primary progressive MS. [12]", "Do not equate relapse control with absence of disability progression. Relapse-associated worsening and progression independent of relapse activity both contribute to disability accumulation, including among patients treated with ocrelizumab; therefore, monitor disability trajectory as well as overt relapses and MRI activity. [12][14]" ], "bullets": [ "Treat rapidly evolving severe relapsing disease as a high-activity phenotype; the fingolimod product information defines this as at least two disabling relapses in 1 year plus at least one gadolinium-enhancing lesion or a significant increase in T2 lesion burden versus a recent MRI. [24]", "For fingolimod, the adult dose in the cited product information is 0.5 mg orally once daily; avoid coadministration with other antineoplastic, immunomodulatory, or immunosuppressive therapies because of additive immunosuppression. [24]", "Avoid live attenuated vaccines during fingolimod treatment and for up to 2 months after treatment; vaccine effectiveness may be reduced during this interval. [24]", "In older adults, recognize that pivotal DMT trials often excluded patients aged 50–55 years or older, patients with significant comorbidity, and those with EDSS scores of 4 or higher; benefit for focal inflammatory activity is reported, whereas benefit for disability worsening remains uncertain. [13]" ], "subsections": [ { "heading": "Monitoring for inadequate inflammatory control", "paragraphs": [ "At follow-up, review interval relapses, new MRI activity, treatment tolerability, and disability change. Continued relapses or progression while on therapy should trigger reassessment of adherence, competing causes of decline, and whether a higher-efficacy or differently targeted therapy is warranted. No absolute criterion defines a nonresponder, so the decision to switch remains individualized. [17][18][19]" ], "bullets": [ "For progressive disability with little inflammatory activity, distinguish progression independent of relapse activity from breakthrough inflammatory disease before changing therapy solely for worsening function. [12][14]", "Refer patients with highly aggressive disease for timely review of high-efficacy options, recognizing the tradeoff between greater efficacy and serious adverse effects. [22]" ] } ], "table": { "caption": "Phenotype- and activity-based treatment considerations. [12][13][19][22][24]", "columns": [ "Clinical pattern", "Treatment implication", "Key tradeoff or monitoring focus" ], "rows": [ [ "Relapsing MS with inflammatory activity", "Start DMT early and aim for suppression of relapses and new MRI activity. [19][23]", "Track relapse frequency, MRI activity, disability, and adverse effects. [19]" ], [ "Highly active relapsing MS", "Consider high-efficacy therapy as initial treatment rather than waiting for inadequate control on lower-efficacy therapy. [12][22]", "Balance greater efficacy against serious treatment-related adverse effects. [22]" ], [ "Primary progressive MS", "Consider ocrelizumab, the approved disease-modifying option identified for PPMS. [12]", "Follow disability trajectory because progressive biology may dominate despite limited overt relapse activity. [12][14]" ], [ "Older adult or patient with substantial comorbidity/disability", "Individualize continuation, initiation, or escalation because trial evidence is less representative of this population. [13]", "Inflammatory benefit is reported; effect on disability worsening is unclear. [13]" ] ] } }, { "id": "pregnancy-and-reproductive-planning", "eyebrow": "Reproductive care", "heading": "Plan disease-modifying therapy around pregnancy before conception", "intro": "Avoid automatic treatment interruption in patients with high inflammatory risk.", "paragraphs": [ "Discuss pregnancy intent before starting or changing a disease-modifying therapy in every patient with childbearing potential. Pregnancy should not automatically delay initiation of DMT, because delaying treatment or routinely stopping treatment before pregnancy or immediately after conception is associated with increased relapse risk during pregnancy and may adversely affect long-term disability. [5][6]", "Relapse frequency decreases naturally during pregnancy, but patients with very active disease may require continued treatment through pregnancy. Individualize this decision against fetal and maternal treatment considerations rather than applying a universal stop rule. [5][6]", "MRI is not contraindicated during pregnancy, but avoid gadolinium contrast when possible. If a disabling relapse occurs, offer intravenous methylprednisolone after excluding infection; plasma exchange is an option for a very severe steroid-refractory relapse. [5][6]" ], "bullets": [ "MS alone does not automatically make pregnancy high risk and should not itself restrict delivery options. [5]", "Counsel before conception rather than waiting for a positive pregnancy test, particularly in patients receiving therapies with persistent immune effects or at high risk of rebound inflammatory activity after interruption. [5][6][24]" ], "subsections": [], "table": { "caption": "Pregnancy-related decisions in multiple sclerosis. [5][6]", "columns": [ "Decision point", "Recommended approach", "Exception or escalation" ], "rows": [ [ "Preconception DMT planning", "Discuss future pregnancy when selecting therapy; do not routinely defer DMT until childbearing is complete. [5][6]", "Consider ongoing treatment during pregnancy for very active disease. [5][6]" ], [ "MRI during pregnancy", "MRI may be performed when clinically needed. [5][6]", "Avoid gadolinium contrast where possible. [5][6]" ], [ "Disabling relapse during pregnancy", "Offer intravenous methylprednisolone after infection is excluded. [5][6]", "Consider plasma exchange for very severe corticosteroid-refractory relapse. [5][6]" ] ] } }, { "id": "functional-and-symptom-care", "eyebrow": "Longitudinal care", "heading": "Treat function-limiting symptoms while monitoring disability independently of relapse activity", "intro": "Symptom control and rehabilitation complement, but do not replace, disease-modifying therapy.", "paragraphs": [ "At each longitudinal visit, separately assess relapse history, treatment-associated complications, disability progression, fatigue, spasticity, mood symptoms, urinary dysfunction, and sexual dysfunction. Symptomatic medications may address these manifestations but do not change the underlying disease course, so a symptomatic response should not be interpreted as evidence of inflammatory control. [23]", "Refer for rehabilitation when gait, upper-extremity function, endurance, or spasticity limits activity. Rehabilitation specialists can improve functioning and quality of life and reduce stiffness and spasms, providing a parallel intervention when immunotherapy cannot reverse established disability. [23]", "When disability worsens without a clear relapse, evaluate for progression independent of relapse activity rather than repeatedly administering relapse therapy. Progressive biology is increasingly recognized in relapsing disease and predominates in progressive MS, while the absence of analogous MRI endpoints limits direct measurement of this process. [12][14]" ], "bullets": [ "Use serial clinical disability assessment alongside relapse and MRI surveillance, because disability accumulation may be relapse associated or relapse independent. [12][14]", "Reassess DMT goals in older patients and those with advanced disability, where evidence for slowing disability worsening is less certain than evidence for suppressing focal inflammatory activity. [13]" ], "subsections": [], "table": { "caption": "Separate targets for longitudinal MS care. [12][13][14][23]", "columns": [ "Target", "Assessment focus", "Management implication" ], "rows": [ [ "Inflammatory activity", "Clinical relapses and new MRI activity. [19][23]", "Reassess DMT effectiveness and treatment strategy. [19]" ], [ "Relapse-independent progression", "Sustained disability worsening without a temporally related relapse. [12][14]", "Avoid assuming corticosteroid-responsive inflammation; reassess phenotype and functional interventions. [12][14]" ], [ "Function and symptoms", "Fatigue, spasticity, mood, bladder, sexual function, and mobility. [23]", "Use targeted symptomatic treatment and rehabilitation; these measures do not alter disease course. [23]" ] ] } } ], "faq": [ { "question": "When should CSF oligoclonal bands change the diagnosis of suspected MS?", "answer": "Use oligoclonal IgG bands or an elevated IgG index to support MS only when the clinical syndrome and MRI pattern are compatible and alternative diagnoses have been excluded; oligoclonal bands are not specific for MS. [1][3][16]" }, { "question": "When should worsening disability prompt a DMT reassessment rather than relapse treatment?", "answer": "Reassess DMT effectiveness when disability worsening accompanies relapses or new MRI activity. If decline occurs without relapse, evaluate progression independent of relapse activity and functional contributors rather than presuming steroid-responsive inflammation. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Applying the 2017 McDonald diagnostic criteria for multiple ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(18)30168-6.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "that CSF oligoclonal bands are not specific for multiple sclerosis and can be used to support the diagnosis only when the overall CSF findings, other", "score": 0.7763013 }, { "number": 2, "title": "Diagnosis of multiple sclerosis: 2024 revisions ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00270-4/fulltext?dgcid=buzzsprout_icw_podcast_September_25_laneur", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "The new 2024 McDonald criteria provide a unified approach for diagnosing multiple sclerosis. MRI and CSF biomarkers.", "score": 0.7325349 }, { "number": 3, "title": "CSF testing for multiple sclerosis", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(05)70151-4/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "by MP Pender · 2005 · Cited by 5 — In the McDonald criteria, a positive CSF study is defined as one showing either oligoclonal IgG bands or a high IgG index, which are two different indicators of", "score": 0.7309246 }, { "number": 4, "title": "Applying the 2024-revised McDonald criteria for multiple ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00351-2/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "The 2024-revised McDonald criteria may enable earlier diagnosis of multiple sclerosis (MS) CSF analysis remained important for diagnosis and differential", "score": 0.6599319 }, { "number": 5, "title": "UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines | Practical Neurology", "detail": "pn.bmj.com", "url": "https://pn.bmj.com/content/19/2/106", "authors": "pn.bmj.com", "host": "pn.bmj.com", "snippet": "Although relapses are less common during pregnancy, any women with MS suffering a disabling relapse should be offered intravenous methylprednisolone at the recommended dose used in MS, regardless of trimester, once an underlying infection, such as a urinary tract infection has been excluded. For ver", "score": 0.6191726 }, { "number": 6, "title": "UK consensus on pregnancy in multiple sclerosis", "detail": "pn.bmj.com", "url": "https://pn.bmj.com/content/practneurol/early/2019/01/05/practneurol-2018-002060.full.pdf", "authors": "pn.bmj.com", "host": "pn.bmj.com", "snippet": "► ► Although relapses are less common during pregnancy, any women with MS suffering a disabling relapse should be offered intravenous methylprednisolone at the recom-mended dose used in MS, regardless of trimester, once an underlying infection, such as a urinary tract infec-tion has been excluded. F", "score": 0.5735118 }, { "number": 7, "title": "Disease modifying therapies for relapsing multiple sclerosis", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/bmj/354/bmj.i3518.full.pdf", "authors": "www.bmj.com", "host": "www.bmj.com", "snippet": "Fig 4 | General approaches to selection of multiple sclerosis (MS) disease modifying therapies (DMTs). These algorithms are general approaches to facilitate", "score": 0.45101276 }, { "number": 8, "title": "AHSCT vs Fingolimod, Natalizumab, and Ocrelizumab in ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/fullarticle/2805036", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by T Kalincik · 2023 · Cited by 73 — ... disease-modifying therapies for relapsing-remitting multiple ... Comparative effectiveness of rituximab in multiple sclerosis.  Nat", "score": 0.6044228 }, { "number": 9, "title": "Design and Implementation of Observational Studies ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2845269", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by Y Ren · 2026 · Cited by 9 — 137. Diouf I, Malpas CB, Sharmin S, et al. Effectiveness of multiple disease-modifying therapies in relapsing-remitting multiple sclerosis:", "score": 0.56690645 }, { "number": 10, "title": "Disease-Modifying Treatments and Time to Loss of ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/fullarticle/2794292", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by E Portaccio · 2022 · Cited by 22 — ... safety of ... Association of rituximab treatment with disability progression among patients with secondary progressive multiple sclerosis.", "score": 0.5565207 }, { "number": 11, "title": "Multiple Sclerosis Outcomes and Treatment Strategies", "detail": "www.nature.com", "url": "https://www.nature.com/nature-index/topics/l4/multiple-sclerosis-outcomes-and-treatment-strategies", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Disease-modifying therapy (DMT): A pharmacological agent aimed at reducing relapse frequency and delaying disability progression. No evidence of disease", "score": 0.49963441 }, { "number": 12, "title": "Real-world evidence of ocrelizumab-treated relapsing multiple sclerosis cohort shows changes in progression independent of relapse activity mirroring phase 3 trials | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-023-40940-w", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "RAW and PIRA contribute to overall disability accumulation. Interestingly, treatment with any disease-modifying agent skewed the overall disability progression towards PIRA, presumably because of prevented relapses under therapy6.\"). [...] PIRA (18.5%), and 3.1% experienced RAW (3.0%) during a mean ", "score": 0.7208996 }, { "number": 13, "title": "Advancing multiple sclerosis management in older adults | Nature Reviews Neurology", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41582-025-01115-5", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "in older people with MS are a major unmet need, and dedicated studies should be designed to assess these strategies by use of non-inferiority frameworks and patient-preference trials, particularly in the context of real-world practice. Use of pragmatic trials, registry-based randomization, observati", "score": 0.6664756 }, { "number": 14, "title": "Estimating individual treatment effect on disability progression in multiple sclerosis using deep learning | Nature Communications", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41467-022-33269-x", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Several disease-modifying therapies have been developed for the treatment of the focal inflammatory manifestations of relapsing-remitting multiple sclerosis (RRMS) (clinical relapses and lesion activity) using the strategy of performing relatively short and small phase 2 trials with a magnetic reson", "score": 0.65252984 }, { "number": 15, "title": "The PRISMA Extension Statement for Reporting of ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/M14-2385", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by B Hutton · 2015 · Cited by 8531 — ... (disability progression over 36 months) of immunomodulators and immunosuppressants for multiple sclerosis. ... Comparative effectiveness and safety", "score": 0.5874941 }, { "number": 16, "title": "Consensus recommendations for diagnosis and treatment of Multiple Sclerosis: 2023 revision of the MENACTRIMS guidelines", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S2211034824000142", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "With evolving diagnostic criteria and the advent of new oral and parenteral therapies for Multiple Sclerosis (MS), most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in spa", "score": 0.7882741 }, { "number": 17, "title": "Treatment of Multiple Sclerosis - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/treatment-of-multiple-sclerosis", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "For the most part, measures aimed at altering disease progression and relapse are immunosuppressive or immunomodulatory, or both. Drugs used in MS include interferon-β, glatiramer acetate, intravenous immunoglobulin, mitoxantrone, methotrexate, and corticosteroids. The most commonly used options hav", "score": 0.7171114 }, { "number": 18, "title": "Understanding the Patient's Journey in the Diagnosis and Treatment of Multiple Sclerosis in Clinical Practice", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0149291818301863", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "2022, Journal of Central Nervous System Disease Show abstract Recently, the number of available disease modifying therapies for multiple sclerosis (MS) has increased. However, a proportion of patients treated with these agents continue to experience relapses and disease progression. Cladribine tabl", "score": 0.65279555 }, { "number": 19, "title": "Update in multiple sclerosis", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2405650225000073", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by B Yamout · 2025 · Cited by 7 — Current treatment guidelines stress the importance of early and complete suppression of inflammatory activity in RRMS, as reflected by relapses and new/", "score": 0.65146625 }, { "number": 20, "title": "Disease‐modifying treatments for multiple sclerosis – a ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/ene.12883", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by Ø Torkildsen · 2016 · Cited by 435 — Common adverse events include flushing, nausea, diarrhoea and abdominal pain 34, 35. The treatment may also reduce white blood cell counts and", "score": 0.41677347 }, { "number": 21, "title": "Disease‐modifying agents for multiple sclerosis and the risk ...", "detail": "bpspubs.onlinelibrary.wiley.com", "url": "https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14916", "authors": "bpspubs.onlinelibrary.wiley.com", "host": "bpspubs.onlinelibrary.wiley.com", "snippet": "While the efficacy of disease-modifying therapies (DMTs) for multiple sclerosis (MS) has been proved, their long-term safety is not apparent.", "score": 0.38117403 }, { "number": 22, "title": "Highly Aggressive Multiple Sclerosis - Continuum", "detail": "journals.lww.com", "url": "https://journals.lww.com/continuum/fulltext/2019/06000/highly_aggressive_multiple_sclerosis.9.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Newly introduced disease-modifying therapies offer greater efficacy than previous therapies but also have serious side effects. This article reviews factors", "score": 0.34713915 }, { "number": 23, "title": "Multiple sclerosis", "detail": "www.who.int", "url": "https://www.who.int/news-room/fact-sheets/detail/multiple-sclerosis", "authors": "www.who.int", "host": "www.who.int", "snippet": "## Diagnosis\n\nMS is a diagnosis of exclusion and there are no definitive diagnostic tests. Magnetic resonance imaging (MRI) can help with diagnosis by showing plaques or sclerosis on the brain and spinal cord. Other tests such as lumbar puncture, optical coherence tomography (OCT) and visual evoked ", "score": 0.5366292 }, { "number": 24, "title": "Fingolimod Mylan - European Medicines Agency (EMA)", "detail": "www.ema.europa.eu", "url": "https://www.ema.europa.eu/en/documents/product-information/fingolimod-mylan-epar-product-information_en.pdf", "authors": "www.ema.europa.eu", "host": "www.ema.europa.eu", "snippet": "Anti-neoplastic, immunomodulatory or immunosuppressive therapies should not be co-administered due to the risk of additive immune system effects (see sections 4.3 and 4.4). Caution should also be exercised when switching patients from long-acting therapies with immune effects such as natalizumab, te", "score": 0.3642578 } ], "publishedAt": "2026-08-21T02:37:04.710695+00:00", "updatedAt": "2026-08-21T02:37:04.710695+00:00", "readingMinutes": 6, "slug": "multiple-sclerosis" }