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...

BACKGROUND-Aging results in decreased neuromuscular function, which is likely associated with neurologic alterations. At present little is known regarding age-related changes in intracortical properties.

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Background: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. Objectives: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic’s impact on healthcare delivery. Methods: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d’Hebron-Centre d’Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. Results: There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Conclusion: Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption.