Brain health: time matters in multiple sclerosis

Abstract

IntroductionWe present international consensus recommendations for improving diagnosis, management and treatment access in multiple sclerosis (MS). Our vision is that these will be used widely among those committed to creating a better future for people with MS and their families. MethodsStructured discussions and literature searches conducted in 2015 examined the personal and economic impact of MS, current practice in diagnosis, treatment and management, definitions of disease activity and barriers to accessing disease-modifying therapies (DMTs). Graphical abstract Keywordsmultiple sclerosis consensus statement treatment strategy disease activity disease-modifying therapy (DMT) magnetic resonance imaging (MRI)Highlights  Consensus recommendations on MS diagnosis, management and treatment are presented.  Neurological reserve, a component of brain health, can compensate for CNS damage.  We propose a therapeutic strategy that aims to maximize lifelong brain health.  Proactive monitoring, shared decision-making and improved treatment access are key.  Early referral, diagnosis and treatment initiation are also of crucial importance.

The Role of High‐Frequency MRI Monitoring in the Detection of Brain Atrophy in Multiple Sclerosis

“…Assessment of BVL in individual patients could facilitate the identification of those with disease progression and are at high risk of accumulating permanent disability . Unfortunately, a relatively high intraindividual variability of longitudinal brain atrophy measures renders challenging its application in individual MS patients .…”

“…Multiple sclerosis (MS) is a heterogeneous autoimmune disease resulting in physical and cognitive disability in the vast majority of the patients. Therefore, individually tailored treatment according to particular disease activity is urgently needed.…”

Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options

“…Alemtuzumab, a monoclonal antibody against cells that express the CD52, has demonstrated greater MRI and clinical improvement in comparison to IFNb-1a in its three pivotal studies in active relapsing MS patients [146][147][148]. Additionally, most patients remained free of disability and MRI progression, for the following 6 years of the initial treatment [6]. Brain atrophy measures showed that brain parenchymal fraction was smaller in Alemtuzumab compared to the INF β-1a treatment arm either in treatment naïve patients [149] or in participants who had relapsed on prior therapy [147][148][149].…”

“…Magnetic resonance imaging (MRI) lesions are wellscattered at white matter (WM) and grey matter (GM) [4], while normal-appearing brain tissue in MRI also seems to be affected in pathological studies [4]. Brain atrophy, the gradual loss of brain volume, is quite extensive in MS, nearly 0.5-1.35% per year, far off the limits of normal aging [5,6]. It arises early in the course of the disease, accelerates with disease progression [7][8][9][10][11][12] but is attenuated by disease-modifying drugs [13].…”

Establishing the diagnosis of multiple sclerosis in Croatian patients with clinically isolated syndrome: 2010 versus 2017 McDonald criteria

“…Although significant advances in the diagnosis and treatment of MS have been made, there is still a considerable delay between the onset of MS-characteristic symptoms and establishing the diagnosis and treating MS (2). The delay in the diagnosis and treatment can have devastating consequences on a person with MS (pwMS), as substantial evidence exists arguing that early treatment is more effective than treatment later in the disease course (3,4). Over the years there have been several attempts to modify the criteria in order to establish the diagnosis of MS earlier and more easily (5,6,7,8,9).…”