Multiple Sclerosis Today: What Every Patient Should Know – Modern Science, Diagnosis, and Treatment

Introduction 

The information presented in this article is entirely based on the authoritative review “Treatment of Multiple Sclerosis: A Review,” published in 2020 in The American Journal of Medicine. The authors of the publication—Prof. Stephen L. Hauser, MD, and Prof. Bruce A.C. Cree, MD, PhD, MAS—are leading neurologists and researchers at the UCSF Weill Institute for Neurosciences and the Department of Neurology, University of California, San Francisco. Professors Hauser and Cree are recognized experts in the field of multiple sclerosis (MS), with decades of clinical and research experience. Their article presents the most up-to-date scientific findings, diagnostic criteria, treatment approaches, and future perspectives for managing MS. The purpose of this text is to help guide patients and their loved ones through the essential aspects of the disease and modern medicine by answering key questions—relying solely on the information provided in this publication.

"Remarkable advances in treatment of all forms of MS, and especially for relapsing disease, have favorably changed the long-term outlook for many patients." — Hauser SL, Cree BAC (2020)

Expert Insights

What Should We Know About the Modern Treatment of Multiple Sclerosis?

Multiple sclerosis is one of the most complex autoimmune disorders of the central nervous system and is a leading cause of non-traumatic neurological disability in young adults. Over the past decade, there has been remarkable progress in understanding and treating the disease. Patients and their families now have access to more effective and personalized treatment strategies. Here are five key expert insights and scientific summaries to help patients and caregivers navigate current approaches and make informed decisions.

1. What is the current understanding of MS pathogenesis and treatment?

"Remarkable advances in treatment of all forms of MS, and especially for relapsing disease, have favorably changed the long-term outlook for many patients. There also has been a conceptual shift in understanding the immune pathology of MS, away from a purely T-cell-mediated model to recognition that B cells have a key role in pathogenesis. The emergence of higher-efficacy drugs requiring less frequent administration have made these preferred options in terms of tolerability and adherence. Many experts now recommend use of these as first-line treatment for many patients with early disease, before permanent disability is evident."

Explanation: Recent research shows that B cells play a central role in MS pathogenesis, leading to the development of more effective therapies targeting them. Increasingly, specialists are recommending these newer treatments in the early stages of the disease to prevent long-term disability.

2. What are the main diagnostic and monitoring methods for MS?

"Diagnosis requires objective evidence of inflammatory CNS injury, and often, additional details of dissemination of the disease process 'in space and time,' that is, affecting more than one CNS location with evolution over time... The main tests used to support diagnoses are magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis."

Explanation: Diagnosing MS requires a comprehensive approach, with emphasis on MRI imaging and cerebrospinal fluid analysis. These tools help not only in confirming the diagnosis but also in tracking disease activity and progression.

3. What are the key treatment strategies for different forms of MS?

"Current management strategies are focused on treating acute attacks, ameliorating symptoms, and reducing biologic activity through disease-modifying therapies... Highly effective therapies have produced near-complete control of relapsing disease and focal brain inflammation. However, effective treatment of progression remains an unmet need because current therapies confer only partial protection against the neurodegenerative component of MS."

Explanation: MS treatment involves three primary strategies: managing acute relapses, alleviating symptoms, and using disease-modifying therapies (DMTs) to reduce biological activity. While relapsing forms are now largely manageable, treating progressive forms remains a significant challenge.

4. What are the leading medications and their characteristics?

"We now recommend the use of highly effective disease-modifying therapies as first-line options for the majority of patients with active MS... We favor initiating therapy for many patients with ocrelizumab or another anti-CD20 drug, or with natalizumab in John Cunningham virus-negative patients. Anti-CD20 therapies represent an attractive option given their high level of efficacy, infrequent infusions or injections, favorable safety profile, and absence of rebound following discontinuation."

Explanation: The most effective current treatments are monoclonal antibodies that selectively reduce the number of B cells (e.g., ocrelizumab, ofatumumab). These therapies are highly effective, require less frequent dosing, and offer a favorable safety profile, making them a preferred option for many patients.

5. When and why should therapy be changed or stopped?

"Switching therapies may be required in the following situations: suboptimal response, experiencing more than one relapse with active MRI scans in the prior year while on treatment, and safety issues including development of persistent high-titer neutralizing antibodies in patients receiving IFN-b. Discontinuation of disease-modifying therapies is required in cases of serious adverse events that may be drug related and for many disease-modifying therapies in women who become pregnant while on treatment. Exceptions include glatiramer acetate that can be continued during pregnancy..."

Explanation: Sometimes a change or discontinuation of therapy is necessary—for example, if treatment response is insufficient, adverse effects occur, or the patient becomes pregnant. While some medications like glatiramer acetate may be safe during pregnancy, most require stopping under medical supervision.

Frequently Asked Questions

1. How common is multiple sclerosis, and does where I live matter? 

Answer: MS is a global health issue, and its prevalence is rising. It is most common in North America, Western Europe, and Australasia (over 100 cases per 100,000 people), while regions near the equator report lower rates (under 30 per 100,000). Women are nearly three times more likely than men to develop relapsing MS, with onset typically around age 30. Primary progressive MS tends to start around age 40 and affects men and women equally.

2. What are the most common initial symptoms of MS? 

Answer: Symptoms vary depending on which part of the central nervous system is affected. Common early signs include sensory loss or numbness, painful vision loss (optic neuritis), limb weakness, double vision, ataxia (unsteady walking), dizziness, urinary issues, fatigue, “brain fog” (trouble concentrating), and paroxysmal symptoms like electric-shock sensations when bending the neck (Lhermitte’s sign).

3. How is an MS diagnosis made? What tests are required? 

Answer: An MS diagnosis requires objective evidence of inflammatory damage in the CNS that has spread to different areas over time. The main diagnostic tools are MRI (to identify characteristic lesions) and CSF analysis (to detect oligoclonal bands and other immune changes). Additional tests may include evoked potentials and optical coherence tomography (OCT) for eye examination.

4. How fast does MS progress, and what are the possible outcomes? 

Answer: MS progresses differently for each person. Most cases start as relapsing-remitting MS (RRMS), with periods of recovery between relapses. Over time, relapses decrease, and gradual worsening occurs—this is known as secondary progressive MS (SPMS). Fewer than 10% of patients have primary progressive MS (PPMS) from the start. Before modern therapies, the average time to significant disability was about 19 years, but new treatments have dramatically improved this outlook.

5. What risks and side effects should I be aware of with today’s MS treatments? 

Answer: Each medication has its own side effect profile. For example, monoclonal antibodies like ocrelizumab may increase the risk of infections (e.g., herpes), while natalizumab carries a risk of a rare but serious brain infection (progressive multifocal leukoencephalopathy), especially in patients with certain viral antibodies. Oral treatments can impact liver function, cause lymphopenia, or lead to other side effects. Treatment choice should be personalized and managed with careful medical monitoring.

Conclusion 

Multiple sclerosis is a dynamic and challenging disease that raises serious concerns for patients and their families. The review by Professors Hauser and Cree summarizes the current scientific understanding and medical practice—from early symptoms and diagnosis to prognosis and treatment risks. Thanks to scientific advancements and innovative medications, treatment options and disease control are significantly better than in the past. The hope for an improved quality of life with MS is real, but it requires informed decisions, active communication with healthcare providers, and regular follow-up tailored to each patient’s individual needs.

Source: Hauser SL, Cree BAC. “Treatment of Multiple Sclerosis: A Review.” The American Journal of Medicine, 2020. https://www.amjmed.com/article/S0002-9343(20)30602-1/fulltext