Association of British Neurologists: revised (2015) guidelines for prescribing disease-modifying treatments in multiple sclerosis

Scolding, Neil; Barnes, David; Cader, Sarah; Chataway, Jeremy; Chaudhuri, Abhijit; Coles, Alasdair; Giovannoni, Gavin; Miller, David H.; Rashid, Waqar; Schmierer, Klaus; Shehu, Abdullah; Silber, Eli; Young, Carolyn A; Zajicek, John

doi:10.1136/practneurol-2015-001139

Cited by 189 publications

(176 citation statements)

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“…According to the 2015 updated guidelines of the Association of British Neurologists (Scolding et al., 2015), initiation of disease‐modifying drugs should be considered within 12 months of a significant CIS, if MRI evidence establishes a diagnosis of MS according to the 2010 McDonald criteria (Polman et al., 2011) or predicts a high likelihood of recurrent episodes. Of note, the 2010 revised criteria of McDonald (Polman et al., 2011) and MAGNISM criteria of 2016 (Filippi et al., 2016) define that a second attack can be diagnosed if there is a new T2 lesion or if there is new enhancing lesion.…”

Section: Introductionmentioning

confidence: 99%

MRI in predicting conversion to multiple sclerosis within 1 year

et al. 2018

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ObjectivesMost patients diagnosed with multiple sclerosis (MS) present with a clinically isolated syndrome (CIS). We aimed to verify previously reported imaging and clinical findings, and to identify new MRI findings that might serve as prognostic factors for a second clinical episode or a change in the MRI scan during the first year following a CIS.Materials and MethodsWe identified from our medical records, 46 individuals who presented with an episode of CIS, which was followed clinically and with imaging studies. A neuroradiologist blinded to the clinical data reviewed the images and recorded the number of lesions, lesion location, and the largest longitudinal diameter of the lesion.ResultsOne year after the first MRI, 25 (54%) patients had progressed to MS. The clinical presentation of those who were and were not diagnosed with MS was predominantly motor or sensory deficit. Patients with lesions that were temporal, occipital, or perpendicular to the corpus callosum at the first episode were more likely to have recurrence. Individuals with a combination of more than 13 lesions, with maximal lesion length greater than 0.75 cm, and a lesion perpendicular to the corpus callosum, had a 19 times higher chance of conversion MS during the following year.ConclusionsAssessment of the number of lesions, lesion location, and maximal lesion size can predict the risk to develop another clinical episode or a new lesion/new enhancement in MRI during the year after CIS. For patients with a higher risk of recurrence, we recommend closer follow‐up.

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Section: Introductionmentioning

confidence: 99%

MRI in predicting conversion to multiple sclerosis within 1 year

et al. 2018

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“…Intravenous methylprednisolone pulsed therapy can be considered in SPMS, but again longterm data are lacking. 4,11 There are a large number of phase III trials using agents such azathioprine, ciclosporin, β-interferon, dirucotide (myelin basic protein), immunoglobulins and cladribine, as well as other immunomodulators, in progressive MS that have been reported over the last 25 years. Unfortunately, the results have essentially been negative.…”

Section: Cis Treatmentmentioning

confidence: 99%

“…24 PML has also been recently observed, much more rarely, with the oral agents fingolimod and dimethylfumarate. 4,11 Switching between agents depends on clinical and radiological criteria. Rules are being developed, based on relapse rate and new T2 lesions or new gadolinium enhancing lesions, eg the Modified Rio Criteria for β-interferon.…”

Section: Rrms Treatmentmentioning

confidence: 99%

“…8,11 In the UK, DMTs are divided into those of moderate efficacy with a reduction in annualised relapse rate (ARR) of 30-50% (category 1: β-interferons, glatiramer acetate, teriflunamide, dimethyl fumarate and fingolimod) and those of higher efficacy with a reduction in ARR of more than 50% (category 2: alemtuzumab and natalizumab). 11 Full details are given in Table 1 . The most serious side effect occurred unexpectedly about a decade ago with natalizumab -a humanised monoclonal antibody against the cell adhesion molecule a4-integrin -where activation of the John Cunningham virus (JCV) resulted in progressive multifocal leukoencephalopathy (PML).…”

Section: Rrms Treatmentmentioning

confidence: 99%

“…3,10 The diagnosis of MS can be further reinforced by paraclinical data in the form of increased latency of evoked potentials, eg visual evoked potentials, and lumbar puncture with the assessment of unmatched oligoclonal immunoglobulin IgG bands in the cerebrospinal fluid (CSF) that are seen in up to 90% of MS patients. 3,5,11 Other disease processes must be considered and actively excluded. A phenocopy that has more recently been established as separate from MS is neuromyelitis optica (NMO) spectrum disorder due in part to the aquaporin-4 antibody and subsequent complement activation.…”

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confidence: 99%

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Multiple sclerosis, a treatable disease

2016

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This article reviews our current understanding and modern treatment of multiple sclerosis (MS). MS is a disabling condition resulting in devastating social and economic impacts. As MS can affect any part of the central nervous system, the presentation is often diverse; however, there are key features that can be useful in the clinic. We comment on the diagnostic criteria and review the main subtypes of MS, including clinically isolated syndrome, relapsing remitting MS, secondary progressive MS and primary progressive MS. Although the underlying aetiology of MS is still not known, we summarise those with most evidence of association. Finally, we aim to present treatment strategies for managing the acute relapse, disease-modifying therapies and MS symptoms. This review highlights that progressive MS is an area where there is currently a paucity of available diseasemodifying treatments and this will be a major focus for future development.KEYWORDS : Diagnostic criteria , epidemiology , multiple sclerosis , progressive multiple sclerosis , treatments What is multiple sclerosis?Multiple sclerosis (MS) is an acquired disabling neurological disease of young adults, affecting approximately 2.3 million people worldwide. It is most prevalent in North America (140 cases per 100,000) and Europe (108 cases per 100,000); the prevalence is lowest in sub-Saharan Africa (2.1 cases per 100,000) and East Asia (2.2 cases per 100,000).1 Overall, there are approximately 120,000 people with MS in the UK. 2MS is an inflammatory disease of the central nervous system (CNS), which causes a heterogeneous array of symptoms and signs because of differential involvement of motor, sensory, visual and autonomic systems. Optic neuritis (inflammation of the optic nerve), Uhthoff's phenomenon (transient fluctuation or worsening of MS symptoms with a rise in body temperature) and Lhermitte's phenomenon (an abnormal electric-shock like sensation down the spine or limbs on neck flexion) are characteristic of MS.3-5 MS relapses occur because of focal areas ABSTRACTMultiple sclerosis, a treatable disease of demyelination evolving over 24 hours and persisting for days or weeks before generally, though not exclusively, improving.4,6

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