ultiple sclerosis (MS) is an autoimmune central nervous system (CNS) disorder characterized by inflammatory demyelination and axonal transection, defined as severed terminal axonal structures representing the pathological correlate of irreversible neurologic damage. MS affects approximately 900 000 people in the US. [1][2][3] MS is typically diagnosed in adults aged 20 to 30 years and often affects physical functioning, cognition, quality of life, and employment. The cause of MS is unclear, but many genetic (eg, major histocompatibility complex HLA-DRB1 locus) and environmental factors, such as vitamin D levels (increased risk at levels <100 nmol/L [40 ng/mL; reference range, 40-60 ng/mL]), ambient UV radiation, Epstein-Barr virus infection, and tobacco smoking, are associated with MS. [4][5][6][7][8][9] Current treatment for MS consists of a multidisciplinary approach including disease-modifying therapies (DMTs), symptomatic treatment, lifestyle modifications, psychological support, and rehabilitation interventions. The first DMT, interferon beta-1b, was approved by the US Food and Drug Administration (FDA) in 1993. As of July 2020 there were 9 classes of DMTs approved for the treatment of MS (interferons, glatiramer acetate, teriflunomide, sphingosine 1-phosphate [S1P] receptor modulators, fumarates, cladribine, natalizumab, ocrelizumab, alemtuzumab). IMPORTANCE Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system characterized by inflammatory demyelination with axonal transection. MS affects an estimated 900 000 people in the US. MS typically presents in young adults (mean age of onset, 20-30 years) and can lead to physical disability, cognitive impairment, and decreased quality of life. This review summarizes current evidence regarding diagnosis and treatment of MS.OBSERVATIONS MS typically presents in young adults aged 20 to 30 years with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days. The prevalence of MS worldwide ranges from 5 to 300 per 100 000 people and increases at higher latitudes. Overall life expectancy is less than in the general population (75.9 vs 83.4 years), and MS more commonly affects women (female to male sex distribution of nearly 3:1). Diagnosis is made based on a combination of signs and symptoms, radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions), and laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands), which are components of the 2017 McDonald Criteria. Nine classes of disease-modifying therapies (DMTs), with varying mechanisms of action and routes of administration, are available for relapsing-remitting MS, defined as relapses at onset with stable neurologic disability between episodes, and secondary progressive MS with activity, defined as steadily increasing neurologic disability following a relapsing course with evidence of ongoing inflammatory activity. These drugs include interfe...

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Background  Good medical care relies on communication as much as technical expertise, yet physicians often overestimate the efficacy of their patient communication skills. Teaching communication skills can be cost- and time-intensive, and efforts have rarely focused on challenging situations, such as conveying the news of a patient's brain death to a family member. Objective  We developed a resource-sensitive simulation program to teach residents how to diagnose brain death and how to show empathy in discussing the diagnosis with the patient's family. Methods  From 2015 to 2017, 3 cohorts of incoming neurology residents participated in the 3-day training exercise. The 2-hour preintervention assessment involved making the diagnosis of brain death and sharing the news with an actor portraying the patient's family member. The scoring via checklists consisted of 15 clinical skills, 9 apnea test–related skills, and 37 verbal skills related to family discussion. The 5-hour didactic intervention focused on technical aspects of the brain death examination and lessons in communication with role-playing. The 2-hour postintervention assessment repeated the brain death examination and family discussion simulations. Data were analyzed using the Wilcoxon signed rank test. Results  A total of 18 residents (100%) were assessed, with significant differences between preintervention and postintervention testing across all areas, including clinical assessment (45%–76%, P &lt; .001), apnea testing (57%–92%, P &lt; .001), and verbal communication (46%–73%, P &lt; .001). Conclusions  The findings suggest a benefit in simulation training for brain death examination, apnea testing, and the subsequent family discussion regarding the patient's diagnosis.

The advent of interferon therapy for the treatment of multiple sclerosis (MS) was a massive advancement in the field and changed the course of the disease. While the exact mechanism of interferon therapy in MS is unknown, disease control is likely mediated by reducing Th1 and Th17 cells while increasing regulatory T cells and altering the cytokine profile. Interferon therapy not only gave physicians and patients an evidence-based treatment option to treat MS by decreasing relapses and the accrual of disability but it also provided valuable insight into disease pathophysiology that allowed for the development of further treatments. Currently, there are 18 disease-modifying therapies available for the treatment of MS with varying efficacies, routes of administration, and mechanisms. As treatment options in the field have evolved, interferon therapy is less commonly prescribed as first-line therapy, because the newer therapies are more effective and better tolerated. That being said, interferons still have a place in the field in both clinical practice and clinical trial research. In this review, we will summarize the safety and efficacy of interferon therapy and discuss its current place in MS care.