Skip to main content
SpringerLink
Log in

Multiple Sclerosis

  • Chapter
  • First Online:
Neurology

  • 3087 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Antinori A, Ammassari A, Giancola ML, et al. Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era. J Neurovirol. 2001;7:323–8.

    Article  CAS  PubMed  Google Scholar 

  • Beck RW, Cleary PA, Anderson MM, et al. A randomized controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med. 1992;326:581–8.

    Article  CAS  PubMed  Google Scholar 

  • Beck RW, Cleary PA, Trobe JD, et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med. 1993;329:1764–9.

    Article  CAS  PubMed  Google Scholar 

  • Berger JR, Aksamit AJ, Clifford DB, et al. PML diagnostic criteria. Consensus statement from the AAN Neuroinfectious Disease Section. Neurology. 2013;80:1430–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bloomgren G, Richman S, Hotermans C, et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012;366:1870–80.

    Article  CAS  PubMed  Google Scholar 

  • Carmosino MJ, Brousseau KM, Arciniegas DB, Corboy JR. Initial evaluations for multiple sclerosis in a university multiple sclerosis center. Arch Neurol. 2005;62:585–90.

    Article  PubMed  Google Scholar 

  • Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 2008;7:1139–51.

    Article  PubMed  Google Scholar 

  • Cohen BA, Barkhof F, Comi G, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362:402–15.

    Article  CAS  PubMed  Google Scholar 

  • Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000;343:1430–8.

    Article  CAS  PubMed  Google Scholar 

  • Confavreux C, O’Connor P, Comi G, et al. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13:247–56.

    Article  CAS  PubMed  Google Scholar 

  • Dahlhaus S, Hoepner R, Chan A, et al. Disease course and outcome of 15 monocentrically treated natalizumab-associated progressive multifocal leukoencephalopathy patients. J Neurol Neurosurg Psychiatry. 2013;84:1068–74.

    Article  PubMed  PubMed Central  Google Scholar 

  • Durelli L, Verdun E, Barbero P, et al. Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study. Lancet. 2002;359:1453–60.

    Article  CAS  PubMed  Google Scholar 

  • Evers S. Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol. 2003;250:542–5.

    Article  CAS  Google Scholar 

  • Fowler CJ, Panicker JN, Drake M, et al. A UK consensus on the management of the bladder in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009;80:470–7.

    CAS  PubMed  Google Scholar 

  • Fox RJ, Miller DH, Phillips JT, et al. Placebo-controlled phase 3 study of oral BG-12 or glatiramer in multiple sclerosis. N Engl J Med. 2012;367:1087–97.

    Article  CAS  PubMed  Google Scholar 

  • Freedman MS, Thompson EJ, Deisenhammer F, et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis. A consensus statement. Arch Neurol. 2005;62:865–70.

    Article  PubMed  Google Scholar 

  • Gold R, Kappos L, Arnold DL, et al. Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N Engl J Med. 2012;367:1098–107.

    Article  CAS  PubMed  Google Scholar 

  • Goodin DS, Frohman EM, Garmany GP, et al. Disease modifying therapies in multiple sclerosis: Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology. 2002;58:169–78.

    Article  CAS  PubMed  Google Scholar 

  • Goodin DS, Frohman EM, Hurwitz B, et al. Neutralizing antibodies to interferon beta: assessment of their clinical and radiographic impact: an evidence report: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007;68:977–84.

    Article  CAS  PubMed  Google Scholar 

  • Goodman AD, Brown TR, Edwards KR, et al. A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Ann Neurol. 2010;68:494–502.

    Article  CAS  PubMed  Google Scholar 

  • Harris JO, Frank JA, Patronas N, McFarlin DE, McFarland HF. Serial gadolinium-enhanced magnetic resonance imaging scans in patients with early, relapsing-remitting multiple sclerosis: implications for clinical trials and natural history. Ann Neurol. 1991;29:548–55.

    Article  CAS  PubMed  Google Scholar 

  • Hume AL, Waxman SG. Evoked potentials in suspected multiple sclerosis: diagnostic value and prediction of clinical course. J Neurol Sci. 1988;83:191–210.

    Article  CAS  PubMed  Google Scholar 

  • Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of phase III multicenter, double-blind placebo-controlled trial. Neurology. 1995;45:1268–76.

    Article  CAS  PubMed  Google Scholar 

  • Kappos L, Radue EW, O’Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387–401.

    Article  CAS  PubMed  Google Scholar 

  • Kimbrough DJ, Fujihara K, Jacob A, et al. Treatment of neuromyelitis optica: review and recommendations. Mult Scler Relat Disord. 2012;1:180–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kis B, Rumberg B, Berlit P. Clinical characteristics of patients with late-onset multiple sclerosis. J Neurol. 2008;255:697–702.

    Article  PubMed  Google Scholar 

  • Klawiter EC, Alvarez E, Xu J, et al. NMO-IgG detected in CSF in seronegative neuromyelitis optica. Neurology. 2009;72:1101–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Koch M, Mostert J, Heersema D, De Keyser J. Tremor in multiple sclerosis. J Neurol. 2007;254:133–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004;364:2106–12.

    Article  CAS  PubMed  Google Scholar 

  • Mandler RN, Davis LE, Jeffery DR, Kornfeld M. Devic’s neuromyelitis optica: a clinicopathological study of 8 patients. Ann Neurol. 1993;34:162–8.

    Article  CAS  PubMed  Google Scholar 

  • Matthews WB. Paroxysmal symptoms in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1975;38:617–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Matthews L, Marasco R, Jenkinson M, et al. Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution. Neurology. 2013;80:1330–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mendez MF, Pogacar S. Malignant monophasic multiple sclerosis or “Marburg’s disease”. Neurology. 1988;38:1153–5.

    Article  CAS  PubMed  Google Scholar 

  • Morrow SA, Stoian CA, Dmitrovic J, et al. The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis. Neurology. 2004;63:1079–80.

    Article  CAS  PubMed  Google Scholar 

  • Myhr KM, Riise T, Vedeler C, et al. Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension. Mult Scler. 2001;7:59–65.

    Article  CAS  PubMed  Google Scholar 

  • O’Connor P, Wolinsky JS, Confavreux C, et al. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365:1293–303.

    Article  PubMed  Google Scholar 

  • Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology. 2009;72:800–5.

    Article  CAS  PubMed  Google Scholar 

  • Okuda DT, Mowry EM, Cree BAC, et al. Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. Neurology. 2011;76:686–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis. Final Optic Neuritis Treatment Trial follow-up. Arch Neurol. 2008;65:727–32.

    Google Scholar 

  • Palace J, Leite MI, Nairne A, Vincent A. Interferon beta treatment in neuromyelitis optica. Increase in relapses and aquaporin 4 antibody titers. Arch Neurol. 2010;67:1016–7.

    Article  PubMed  Google Scholar 

  • Panitch H, Goodin DS, Francis G, et al. Randomized, comparative study of interferon-beta-1a treatment regimens in MS: the EVIDENCE trial. Neurology. 2002;59:1496–506.

    Article  CAS  PubMed  Google Scholar 

  • Pittock SJ, Lennon VA, Krecke K, et al. Brain abnormalities in neuromyelitis optica. Arch Neurol. 2006;63:390–6.

    Article  PubMed  Google Scholar 

  • Polman CH, O’Connor PW, Havrdova E, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354:899–910.

    Article  CAS  PubMed  Google Scholar 

  • Polman CH, Bertolotto A, Deisenhammer F, et al. Recommendations for the use of data on neutralising antibodies to interferon-beta therapy in multiple sclerosis. Lancet Neurol. 2010;7:740–50.

    Article  Google Scholar 

  • Popescu BFG, Lennon VA, Parisi JE, et al. Neuromyelitis optica unique area postrema lesions. Nausea, vomiting, and pathogenic implications. Neurology. 2011;76:1229–37.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rio J, Nos C, Tintore M, et al. Assessment of different treatment failure criteria in a cohort of relapsing-remitting multiple sclerosis treated with interferon beta: implications for clinical trials. Ann Neurol. 2002;52:400–6.

    Article  CAS  PubMed  Google Scholar 

  • Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005;76:469–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tintore M, Rovira A, Rio J, et al. Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology. 2008;70:1079–83.

    Article  CAS  PubMed  Google Scholar 

  • van Walderveen MA, Kamphorst W, Scheltens P, et al. Histopathologic correlate of hypointense lesions on T1-weighted spin-echo MRI in multiple sclerosis. Neurology. 1998;50:1282–8.

    Article  PubMed  Google Scholar 

  • Vermersch P, Kappos L, Gold R, et al. Clinical outcomes of natlizumab-associated progressive multifocal leukoencephalopathy. Neurology. 2011;76:1697–704.

    Article  CAS  PubMed  Google Scholar 

  • Wenning W, Haghikia A, Laubenberger J, et al. Treatment of progressive multifocal leukoencephalopathy associated with natalizumab. N Engl J Med. 2009;361:1075–80.

    Article  CAS  PubMed  Google Scholar 

  • Wingerchuk DM, Hogancamp WF, O’Brien PC, Weinshenker BG. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology. 1999;53:1107–14.

    Article  CAS  PubMed  Google Scholar 

  • Zorro O, Lobato-Polo J, Kano H, et al. Gamma knife radiosurgery for multiple sclerosis–related trigeminal neuralgia. Neurology. 2009;73:1149–54.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Andrew Tarulli

Authors
  1. Andrew Tarulli
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Tarulli, A. (2016). Multiple Sclerosis. In: Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-29632-6_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29632-6_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29630-2

  • Online ISBN: 978-3-319-29632-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation