What's new in multiple sclerosis?

Abstract

The past 20 years have brought several important advances in the management of multiple sclerosis (MS). Magnetic resonance imaging (MRI) has given us a window into this disease and has transformed the diagnostic process, allowing it to be made much earlier. It has also been established that immunomodulation can prevent demyelinating events in relapsing remitting MS (RRMS). These developments impact on primary care because there is increasing evidence that early diagnosis and treatment of MS may delay, or even prevent the previously inevitable disability.1 At the other end of the spectrum, people with MS with disability are increasingly being managed in the community away from secondary care. The National Institute for Health and Care Excellence (NICE) has recently published an updated guideline for MS patient care. This article highlights the new developments and NICE guidance. MS is the most common cause of non-traumatic neurological disability in young adults with a prevalence of around 1 in 1000 and evidence that the incidence is increasing.2 It is a chronic, progressive, demyelinating condition of the central nervous system (CNS) that typically presents during the ages of 20–40 years, occurring twice as frequently in females as in males. Typically, a large GP practice will have between 10–20 patients with MS.3 Despite the highly heterogeneous course, a number of distinct subtypes have been identified. The most common is the relapsing remitting form (RRMS), which accounts for 80–90% of all cases. This is characterised by demyelinating events where there is loss-of-function, inter-spaced by periods of partial or complete recovery. After 10 years around 50% of those with RRMS will go onto develop secondary progressive MS (SPMS) with fewer relapses but a progressive worsening of disability. Around 10% of patients with MS have a progressive decline in disability …