Multiple Sclerosis

Abstract

It is estimated that there are 300,000 people with multiple sclerosis (MS) in the United States and 2.3 million worldwide. Each MS attack can affect function in cognitive, emotional, motoric, sensory, or visual domains. Patients are often struck in the prime of their lives as they attempt to move forward with career, and family. Since the previous 2010 Seminars in Neurology Pearls and Pitfalls issue, the world of MS has drastically changed and advanced. Here the authors address the ever-changing MS world in both treatment options and diagnostics, covering easily missed differential diagnoses, newly available immunomodulatory therapy, and the challenges of safely treating patients.

Keywords

multiple sclerosis - immunomodulatory treatment

• References

• 1 Multiple Sclerosis International Federation Available at: http://www.msif.org/about-ms/what-is-ms/ . Updated 2015. Accessed October 1, 2015
• 2 Campbell JD, Ghushchyan V, Brett McQueen R , et al. Burden of multiple sclerosis on direct, indirect costs and quality of life: National US estimates. Mult Scler Relat Disord 2014; 3 (2) 227-236
• 3 Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B ; CDBE2010 study group; European Brain Council. The economic cost of brain disorders in Europe. Eur J Neurol 2012; 19 (1) 155-162
• 4 Ivanova JI, Birnbaum HG, Samuels S, Davis M, Phillips AL, Meletiche D. The cost of disability and medically related absenteeism among employees with multiple sclerosis in the US. Pharmacoeconomics 2009; 27 (8) 681-691
• 5 Frohman EM, Greenberg BM. Pearls: multiple sclerosis. Semin Neurol 2010; 30 (1) 97-101
• 6 Lublin FD, Reingold SC, Cohen JA , et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology 2014; 83 (3) 278-286
• 7 Polman CH, Reingold SC, Edan G , et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol 2005; 58 (6) 840-846
• 8 Polman CH, Reingold SC, Banwell B , et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald Criteria. Ann Neurol 2011; 69 (2) 292-302
• 9 Miller DH, Weinshenker BG, Filippi M , et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 2008; 14 (9) 1157-1174
• 10 Wingerchuk DM, Banwell B, Bennett JL , et al; International Panel for NMO Diagnosis. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85 (2) 177-189
• 11 Bentley P, Wang T, Malik O , et al. CADASIL with cord involvement associated with a novel and atypical NOTCH3 mutation. J Neurol Neurosurg Psychiatry 2011; 82 (8) 855-860
• 12 Menezes Cordeiro I, Nzwalo H, Sá F , et al. Shifting the CARASIL paradigm: report of a non-Asian family and literature review. Stroke 2015; 46 (4) 1110-1112
• 13 Vahedi K, Alamowitch S. Clinical spectrum of type IV collagen (COL4A1) mutations: a novel genetic multisystem disease. Curr Opin Neurol 2011; 24 (1) 63-68
• 14 Gascón-Bayarri J, Mañá J, Martínez-Yélamos S, Murillo O, Reñé R, Rubio F. Neurosarcoidosis: report of 30 cases and a literature survey. Eur J Intern Med 2011; 22 (6) e125-e132
• 15 Bridel C, Courvoisier DS, Vuilleumier N, Lalive PH. Cerebrospinal fluid angiotensin-converting enzyme for diagnosis of neurosarcoidosis. J Neuroimmunol 2015; 285: 1-3
• 16 Zajicek JP, Scolding NJ, Foster O , et al. Central nervous system sarcoidosis—diagnosis and management. QJM 1999; 92 (2) 103-117
• 17 Hoitsma E, Drent M, Sharma OP. A pragmatic approach to diagnosing and treating neurosarcoidosis in the 21st century. Curr Opin Pulm Med 2010; 16 (5) 472-479
• 18 Huang JF, Aksamit AJ, Staff NP. MRI and PET imaging discordance in neurosarcoidosis. Neurology 2012; 79 (10) 1070
• 19 Bolat S, Berding G, Dengler R, Stangel M, Trebst C. Fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in the diagnosis of neurosarcoidosis. J Neurol Sci 2009; 287 (1–2) 257-259
• 20 Eckstein C, Saidha S, Sotirchos ES , et al. Detection of clinical and subclinical retinal abnormalities in neurosarcoidosis with optical coherence tomography. J Neurol 2012; 259 (7) 1390-1398
• 21 Parikh S, Bernard G, Leventer RJ , et al; GLIA Consortium. A clinical approach to the diagnosis of patients with leukodystrophies and genetic leukoencephelopathies. Mol Genet Metab 2015; 114 (4) 501-515
• 22 Ahmed RM, Murphy E, Davagnanam I , et al. A practical approach to diagnosing adult onset leukodystrophies. J Neurol Neurosurg Psychiatry 2014; 85 (7) 770-781
• 23 Cohen BA, Coyle PK, Leist T, Oleen-Burkey MA, Schwartz M, Zwibel H. Therapy Optimization in Multiple Sclerosis: a cohort study of therapy adherence and risk of relapse. Mult Scler Relat Disord 2015; 4 (1) 75-82
• 24 Data on file S. Summary of safety HMR1726-teriflunomide. Available at: https://www.aubagiohcp.com/?cid=hcpred . Updated 2013. Accessed September 21, 2015
• 25 Confavreux C, O'Connor P, Comi G , et al; TOWER Trial Group. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2014; 13 (3) 247-256
• 26 Leist T, Freedman M, Kappos L , et al. Pooled safety analyses from teriflunomide clinical studies (P7.268). Neurology 2015; 84 (14) P7.268
• 27 Novartis. Gilenya information center. Available at: https://www.novartis.com/news/statements/gilenya-information-center . Updated 2015. Accessed September 21, 2015
• 28 Calabresi PA, Radue EW, Goodin D , et al. Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol 2014; 13 (6) 545-556
• 29 National MS. Society. Stay informed. Available at: https://www.nationalmssociety.org/Sign-In?ReturnURL=/My-Profile/Communication-Preferences&type=stayinformed . Accessed September 15, 2015
• 30 Langer-Gould A, Atlas SW, Green AJ, Bollen AW, Pelletier D. Progressive multifocal leukoencephalopathy in a patient treated with natalizumab. N Engl J Med 2005; 353 (4) 375-381
• 31 Abdelwahab HS. International TYSABRI Update. Biogen data on file. March 24, 2016
• 32 Plavina T, Subramanyam M, Bloomgren G , et al. Anti-JC virus antibody levels in serum or plasma further define risk of natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol 2014; 76 (6) 802-812
• 33 Nieuwkamp DJ, Murk JL, van Oosten BW , et al; PML in Dutch MS Patients Consortium. PML in a patient without severe lymphocytopenia receiving dimethyl fumarate. N Engl J Med 2015; 372 (15) 1474-1476
• 34 Pfender N, Jelcic I, Linnebank M, Schwarz U, Martin R. Reactivation of herpesvirus under fingolimod: a case of severe herpes simplex encephalitis. Neurology 2015; 84 (23) 2377-2378
• 35 Ricklin ME, Lorscheider J, Waschbisch A , et al. T-cell response against varicella-zoster virus in fingolimod-treated MS patients. Neurology 2013; 81 (2) 174-181
• 36 Kappos L, Freedman MS, Polman CH , et al; BENEFIT Study Group. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol 2009; 8 (11) 987-997
• 37 Freedman MS, Comi G, De Stefano N , et al. Moving toward earlier treatment of multiple sclerosis: Findings from a decade of clinical trials and implications for clinical practice. Mult Scler Relat Disord 2014; 3 (2) 147-155
• 38 Lus G, Signoriello E, Maniscalco GT, Bonavita S, Signoriello S, Gallo C. Treatment withdrawal in relapsing-remitting multiple sclerosis: a retrospective cohort study. Eur J Neurol 2016; 23 (3) 489-493
• 39 Le Page E, Veillard D, Laplaud DA , et al; COPOUSEP investigators; West Network for Excellence in Neuroscience. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet 2015; 386 (9997) 974-981
• 40 Bayry J, Hartung HP, Kaveri SV. IVIg for relapsing-remitting multiple sclerosis: promises and uncertainties. Trends Pharmacol Sci 2015; 36 (7) 419-421
• 41 Ascherio A, Munger KL, Simon KC. Vitamin D and multiple sclerosis. Lancet Neurol 2010; 9 (6) 599-612
• 42 Mowry EM, Krupp LB, Milazzo M , et al. Vitamin D status is associated with relapse rate in pediatric-onset multiple sclerosis. Ann Neurol 2010; 67 (5) 618-624
• 43 Mowry EM, Waubant E, McCulloch CE , et al. Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis. Ann Neurol 2012; 72 (2) 234-240
• 44 Sotirchos ES, Bhargava P, Eckstein C , et al. Safety and immunologic effects of high- vs low-dose cholecalciferol in multiple sclerosis. Neurology 2016; 86 (4) 382-390
• 45 Fitzgerald KC, Munger KL, Köchert K , et al. Association of vitamin D levels with multiple sclerosis activity and progression in patients receiving interferon beta-1b. JAMA Neurol 2015; 72 (12) 1458-1465
• 46 Zamboni P, Galeotti R, Menegatti E , et al. A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 2009; 50 (6) 1348-58.e1 , 3
• 47 Juenemann M, Yeniguen M, Stolz E, Berghoff M. No evidence for CCVSI in relapsing-remitting multiple sclerosis patients with moderate disability. J Neurol 2013; 260 (9) 2409-2410