Improving Outcomes in Multiple Sclerosis Through Early Diagnosis and Effective Management

Abstract

CME BACKGROUND Original material is selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME activities on a variety of topics from volume to volume. To obtain credit, read the material and go to PrimaryCareCompanion.com to complete the Posttest and Evaluation online. CME OBJECTIVE After studying this case, you should be able to: Recognize and correctly diagnose MS, especially during the early stages Develop an individualized, evidence-based treatment plan that includes a disease-modifying treatment and any other appropriate interventions to maintain optimal functioning and quality of life Educate patients about their disease and foster their involvement in the treatment process ACCREDITATION STATEMENT The University of North Texas Health Science Center at Fort Worth is accredited by the American Osteopathic Association to award continuing medical education to physicians. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The University of North Texas Health Science Center and the CME Institute of Physicians Postgraduate Press, Inc. The University of North Texas Health Science Center is accredited by the ACCME to provide continuing medical education for physicians. CREDIT DESIGNATION The University of North Texas Health Science Center has requested that the AOA Council on Continuing Medical Education approve this program for 1.0 hour of AOA Category 2B CME credits. Approval is currently pending. The University of North Texas Health Science Center designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. DATE OF ORIGINAL RELEASE/REVIEW This educational activity is eligible for AMA PRA Category 1 Credit™ through October 31, 2013. The latest review of this material was September 2012. FINANCIAL DISCLOSURE The faculty for this CME activity, the CME Institute staff, and the University of North Texas Health Science Center staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute and the University of North Texas Health Science Center have resolved any conflicts of interest that were identified. No member of the CME Institute staff or the University of North Texas Health Science Center staff reported any relevant personal financial relationships. Faculty financial disclosure appears with the article. Clinical Points ▪ Patients with MS may present clinically with eye problems, mobility issues, bowel and bladder problems, cognitive deficits, muscle weakness, and fatigue. ▪ The revised diagnostic criteria for MS require the presence of more than 2 silent lesions with dissemination in space and time. ▪ In addition to using diagnostic criteria, clinicians must take a thorough patient history and complete a differential diagnosis. ▪ A referral to a neurologist is necessary if the patient presents with new neurologic symptoms. ▪ Medications are available to manage the symptoms of MS and to slow the disability and prevent exacerbations associated with the disease progression, but at this time there is no cure for MS. Multiple sclerosis (MS) is one of the most prevalent diseases of the nervous system, affecting about 400,000 people in the United States.1 MS appears more frequently in women, in people aged 20 to 50 years, and in people living farther from the equator. As a chronic autoimmune disorder, MS results in demyelination and neurodegeneration. Although the cause is unknown, white blood cells (or T cells) are activated, leave the bloodstream, and infiltrate the blood-brain barrier. In the central nervous system (CNS), the T cells release proinflammatory cytokines, which attract other cells to attack and damage myelin sheaths that protect neuronal fibers, leading to scarring and axonal injury. This damage can affect patients’ mobility, vision, and/or cognitive functioning, especially if left untreated, which underscores the importance of the early recognition of MS. The overall etiology of MS is unclear, but researchers have studied several genes and environmental factors that may increase the risk of this condition. Although MS is not directly hereditary, having a family member with MS does appear to increase the risk.1 Environmental factors may include low exposure to sunlight and vitamin D deficiency, which could explain why areas farther from the equator have more cases of MS. Exposure to certain viruses, such as measles or Epstein-Barr, may also predispose people to developing MS. By following guidelines and completing diagnostic tests to accurately recognize the disorder as early as possible and by initiating appropriate treatments or referring to a specialist, clinicians can greatly reduce the damaging and irreversible course of MS.