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Overview of the management of relapsing−remitting multiple sclerosis and practical recommendations
Author(s) -
Gallo P.,
Van Wijmeersch B.
Publication year - 2015
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12799
Subject(s) - medicine , glatiramer acetate , multiple sclerosis , relapsing remitting , disease , magnetic resonance imaging , clinically isolated syndrome , window of opportunity , spinal cord , pediatrics , intensive care medicine , radiology , immunology , psychiatry , real time computing , computer science
The initial phases of the clinical course of relapsing−remitting multiple sclerosis ( MS ) are characterized by a mainly inflammatory pathology which gives way to a largely neurodegenerative process as the disease evolves. As all currently available disease‐modifying therapies aim to control inflammation, the window of opportunity for use is early in the disease course, specifically at the time of a clinically isolated syndrome suggestive of MS or in the early stages of relapsing−remitting MS . Approximately 30% of patients treated with first‐line immunomodulators (interferon‐β or glatiramer acetate) show a suboptimal response during the first 1–2 years and require a switch to an alternative therapy. It is recommended not to wait too long to switch in order to prevent disease progression. Patients with a poor prognosis in particular may require a timely switch to a second‐line agent. Regular monitoring of disease and therapy in patients with MS is essential. In the first year after diagnosis, clinical evaluations (neurological status, symptomatic assessment, patient well‐being) should be performed at baseline, 3, 6 and 12 months, and then every 6 months thereafter. Brain magnetic resonance imaging ( MRI ) should be performed every 6 months in the first year of treatment, and at least once yearly thereafter. A spinal cord MRI should be performed once yearly in patients presenting spinal symptoms.