A Review of Multiple Sclerosis for Urologists and Urogynecologists with an Emphasis on Management

Abstract

Multiple sclerosis is a common immune-mediated condition of the central nervous system. It remains one of the most disabling conditions affecting young people, and there is significant cost associated with managing this condition. Revisions of the diagnostic criteria have contributed to better identification and diagnosis of the condition, but consensus approaches to managing the condition are not fully established. Approaches to managing acute demyelination, chronic demyelination, and symptomatic treatments are reviewed. The most common treatment for acute demyelination continues to be the use of corticosteroids via the intravenous or oral routes. Duration of corticosteroid treatment is variable, but high dose treatment is commonly administered over 3 to 7 days. There is a growing arsenal of medications to treat chronic demyelination that includes the use of self-administered injections, daily oral immunomodulation, and intravenous infusions each with their own set of pros and cons. While it is important to address both acute and chronic demyelination, symptomatic treatment should always be addressed to increase the overall quality of activities of daily living. Individuals with multiple sclerosis are all phenotypically different, and careful consideration should be used to individualize therapy for those living with this disease state. As with other autoimmune conditions, not all patients with multiple sclerosis will require long-term chronic therapy. However, chronic immunomodulatory treatments should be offered to all patients to prevent future disease activity until reliable biomarkers are established. Much remains unknown about the pathophysiology of this condition, but advancements in treatment suggest the future is promising for those affected by this condition.