Diagnosis and treatment of multiple sclerosis: MENACTRIMS consensus guidelines

Abstract

With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need re-evaluation and updating. The purpose of the revised MENACTRIMS guidelines is to provide actual recommendations and algorithms on diagnosis and treatment of MS based on scientific evidence and clinical experience. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The 2010 Mc Donald criteria are the cornerstone for diagnosis of all forms of MS. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. The guidelines include a detailed list of red flags, differential diagnoses based on presenting clinical syndromes, and appropriate laboratory tests. Appropriate multiple sclerosis (MS) therapy selection is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting current therapies and provide recommendations for treatment of acute relapses, clinically isolated syndrome, relapsing remitting MS, secondary progressive MS, and primary progressive MS. Recommendations on defining suboptimal response and therefore the need for treatment escalation are provided based on current scientific evidence. A significant number of patients will fulfill criteria for suboptimal response while on treatment with first line drugs. There is currently no class I evidence supporting the choice of a second line therapy. Recommendations for escalation therapy are made based on available scientific data and personal experience. Algorithms for treatment of clinically isolated syndrome and relapsing remitting MS will be presented. With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need re-evaluation and updating. The purpose of the revised MENACTRIMS guidelines is to provide actual recommendations and algorithms on diagnosis and treatment of MS based on scientific evidence and clinical experience. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The 2010 Mc Donald criteria are the cornerstone for diagnosis of all forms of MS. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. The guidelines include a detailed list of red flags, differential diagnoses based on presenting clinical syndromes, and appropriate laboratory tests. Appropriate multiple sclerosis (MS) therapy selection is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting current therapies and provide recommendations for treatment of acute relapses, clinically isolated syndrome, relapsing remitting MS, secondary progressive MS, and primary progressive MS. Recommendations on defining suboptimal response and therefore the need for treatment escalation are provided based on current scientific evidence. A significant number of patients will fulfill criteria for suboptimal response while on treatment with first line drugs. There is currently no class I evidence supporting the choice of a second line therapy. Recommendations for escalation therapy are made based on available scientific data and personal experience. Algorithms for treatment of clinically isolated syndrome and relapsing remitting MS will be presented.