In this article, the author discusses her personal approach to treating individuals with multiple sclerosis. Multiple sclerosis is the major acquired CNS disease of young adults. Untreated, it can lead to permanent disability. There are two primary disease forms: relapsing and progressive. Relapsing multiple sclerosis is characterized by focal inflammation leading to neurologic attacks (also called relapses, exacerbations, or flare-ups). There is acute onset of neurologic deficits over hours to days, followed by a typical recovery period (recovery is generally complete early and incomplete later). Individuals are clinically stable between relapses. Progressive multiple sclerosis is characterized by neurodegeneration that results in slow worsening, with gradual accumulating deficits apparent over months at a time.
Since 1993, multiple disease-modifying therapies have been developed and approved to treat, in particular, relapsing forms of multiple sclerosis. Choosing the optimal disease-modifying therapy is key. Other treatment domains involve management of acute relapses, multiple sclerosis symptoms, and steps to enhance CNS reserve (optimized lifestyle choices, a comprehensive wellness program, and identification and optimized management of damaging comorbidities). Therapeutic multiple sclerosis principles are emerging. Treatment is changing the natural history of this disease and will, hopefully, allow most individuals to lead a normal life.
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• Untreated multiple sclerosis involves accumulating permanent damage to the CNS.
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• For most individuals, multiple sclerosis is a highly treatable disease.
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• Early treatment is important.