Stella E Hughes and Gabrielle Macaron - Fast Facts: Multiple Sclerosis, Fifth Edition

Fast Facts: Multiple Sclerosis

First published 2000; second edition 2006; third edition 2014; fourth edition 2016

Fifth edition 2021

Text 2021 Stella E Hughes, Gabrielle Macaron

2021 in this edition S. Karger Publishers Ltd

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ISBN 978-3-318-06797-2

Hughes SE (Stella)

Fast Facts: Multiple Sclerosis/

Stella E Hughes, Gabrielle Macaron

Medical illustrations by Annamaria Dutto, Withernsea, UK.

Typesetting by Amnet, Chennai, India.

Printed in the UK with Xpedient Print.

9-HPT: 9-hole peg test

AAN: American Academy of Neurology

ACTH: adrenocorticotropic hormone

ADEM: acute disseminated encephalomyelitis

ADL: activities of daily living

AHSCT: autologous hematopoietic stem cell transplantation

AQP-4: aquaporin 4

bd: twice daily

CIS: clinically isolated syndrome

CNS: central nervous system

CSF: cerebrospinal fluid

CT: computed tomography

DHODH: dihydroorotate dehydrogenase

DIS: dissemination in space

DIT: dissemination in time

DMT: disease-modifying therapy

EAN: European Academy of Neurology

EBV: EpsteinBarr virus

ECTRIMS: European Committee of Treatment and Research in Multiple Sclerosis

EDSS: Expanded Disability Status Scale

EMA: European Medicines Agency

FDA: (US) Food and Drug Administration

FLAIR: fluid-attenuated inversion recovery

HLA: human leukocyte antigen

IFN-: interferon-beta

IgG: immunoglobulin G

IL: interleukin

INO: internuclear ophthalmoplegia

IPMSSG: International Pediatric Multiple Sclerosis Study Group

i.v.: intravenous

JC: John Cunningham (virus)

MHC: major histocompatibility complex

MOG: myelin oligodendrocyte glycoprotein

MRI: magnetic resonance imaging

MS: multiple sclerosis

MSFC: Multiple Sclerosis Functional Composite

MSN: multiple sclerosis specialist nurse

NEDA: no evidence of disease activity

NMO: neuromyelitis optica

NMOSD: neuromyelitis optica spectrum disorder

Nrf2: nuclear factor (erythroid-derived 2)-like 2

PCR: polymerase chain reaction

PEG: percutaneous enteral gastrostomy

PLEX: plasma exchange

PML: progressive multifocal leukoencephalopathy

POMS: pediatric-onset multiple sclerosis

PPMS: primary progressive multiple sclerosis

PRMS: progressive relapsing multiple sclerosis

RCT: randomized controlled trial

RIS: radiologically isolated syndrome

RRMS: relapsing remitting multiple sclerosis

S1P: sphingosine 1-phosphate

SDMT: Symbol Digit Modalities Test

SLE: systemic lupus erythematosus

SNRI: serotoninnorepinephrine reuptake inhibitor

SPMS: secondary progressive multiple sclerosis

STIR: short time inversion recovery

T25FW: timed 25-foot walk

TKI: tyrosine kinase inhibitor

TNF: tumor necrosis factor

UTI: urinary tract infection

UV: ultraviolet (light)

VCAM1: vascular cell adhesion molecule-1

WHO: World Health Organization

Multiple sclerosis (MS) is a leading cause of disability in young adults, and it has a significant effect on patients quality of life, family plans and careers. By causing varying degrees of physical and cognitive disability, MS carries a considerable individual and societal economic burden.

Fortunately, we are entering a new era in the management of MS. Several recent studies support initiating treatment early in the disease course with higher-efficacy disease-modifying therapies in patients with relapsing-remitting MS. This approach has been associated with better long-term outcomes, specifically a lower risk of conversion to secondary progressive MS. Moreover, new molecules with the potential to induce myelin repair or halt the neurodegenerative process are in the pipeline for the treatment of progressive MS. Coupled with a recent update to the diagnostic criteria, clinicians can now diagnose and treat patients in the earliest phases of their disease.

In this new edition of Fast Facts: Multiple Sclerosis, we present the latest evidence on disease pathogenesis and all clinical aspects of the condition, as well as the latest on disease-modifying therapies and other potential treatments.

Given the need for multidisciplinary management of MS, we have written this resource for the benefit of all health professionals involved in the care of patients with this complex disease.

Acknowledgments. The authors wish to thank the authors of the third and fourth editions of this resource, Drs Michael Barnett, Omar Malik, Ann Donnelly, Mary Rensel and Orla Gray, for the strong foundation on which this new edition is based.

Multiple sclerosis (MS) is a neurological condition resulting from inflammation and degeneration within the central nervous system (CNS). This inflammation can affect different sites at different times, producing a variety of symptoms and signs. Periods of relapse and remission occur in the early stages of the disease, and in most patients a slowly progressive course ensues within one to two decades of disease onset. The cause of MS is unknown, but dysregulation of the immune system is central to the pathogenesis of the disease.

MS is the leading cause of neurological disability in the young and middle-aged populations of the developed world. Survey figures from 2020 suggest that it affects 2.8 million people worldwide. Given the lack of complete surveillance data in some countries, this is likely to be an underestimate.