Multiple Sclerosis

Abstract

Expertise in the management of multiple sclerosis (MS), the most common demyelinating disorder of the central nervous system, requires mastery of four distinct disease stages. A clinically isolated syndrome suggestive of MS often poses a substantial diagnostic challenge, as there is no single definitive diagnostic test for MS, and there are numerous MS imitators. Important items in the differential diagnosis of MS include neuromyelitis optica, acute disseminated encephalomyelitis, and progressive multifocal leukoencephalopathy. Relapsing-remitting MS leads to frequent hospital admissions during MS flares, and requires familiarity with disease-modifying agents and their potential side effects. Progressive MS is defined by the accumulation of disability. Management of this stage is dominated by understanding not only disease-modifying agents, but also by knowing how to manage the long-term complications of MS. Fulminant MS is a rapidly progressive but fortunately uncommon variant of the disease which requires aggressive immunosuppressive therapy for which supporting high-quality evidence is frequently unavailable.