Treatment of acute exacerbations of multiple sclerosis in adults
- Michael J Olek, DO
Michael J Olek, DO
- Associate Professor of Neurology
- Loma Linda University Medical Center
Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system that is a leading cause of disability in young adults.
Despite dramatic advances in the clinical assessment of MS due to the widespread availability of brain and spine MRI, our understanding of the basic etiology of the disease remains limited. Full control of the disease and the repair of damaged myelin are key objectives for current and future investigators.
The treatment of acute exacerbations of MS is reviewed here. Other aspects of MS treatment are discussed separately. (See "Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults" and "Treatment of progressive multiple sclerosis in adults" and "Symptom management of multiple sclerosis in adults".)
Indications for treatment of an acute exacerbation (relapse) in patients with MS include functionally disabling symptoms with objective evidence of neurologic impairment such as loss of vision, motor, and/or cerebellar symptoms. Mild sensory attacks are often not treated in the same manner, although symptomatic relief is sometimes necessary because of patient discomfort (eg, due to paresthesia).
Patients with relapsing-remitting MS who manifest current disease activity by either clinical symptoms or recent MRI lesions should be offered treatment with disease-modifying therapy. This is discussed separately. (See "Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults", section on 'Starting disease-modifying therapy'.)
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