Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system, which affects women approximately three times as often as men. Approximately 1 in every 1000 people develop MS, with a mean age of onset of 30 years.1

Although MS is notoriously heterogeneous, in 85% of patients, it begins with episodic, largely reversible neurologic dysfunction in a pattern termed relapsing-remitting MS (RRMS). In 75% of those patients, the disease advances over time to steady, irreversible worsening (secondary-progressive MS). Less than 5% of patients have very severe disability (fulminant MS) within 5 years after onset, and 10% to 20% of patients remain unimpaired without therapy for 20 years.

Clinically isolated syndrome (CIS) is known as the first neurological episode suggestive of MS, which often does not meet the standard diagnostic criteria for a definitive MS diagnosis. Those diagnosed with CIS and have magnetic resonance imaging (MRI) features that are suggestive of MS are at high risk for developing definitive MS. For this reason, current recommendations advocate for the treatment of patients with CIS to be initiated upon diagnosis to avoid a high risk of recurrence, effectively delaying or preventing a second neurologic episode and the onset of MS.1-2

The disease has a modest effect on longevity but takes a heavy toll on quality of life. Natural history studies show that half of untreated patients with MS will lose employment 10 years after diagnosis, require assistive walking devices within 15 years, and lose the ability to walk entirely within 25 years.1 In the United States, total yearly costs related to treating patients with MS exceed $14 billion.1

Although recent advances in the understanding the pathophysiology, diagnosis, and clinical monitoring of patients with MS have significantly increased the ability to detect and manage disease progression, experts continue to examine the most appropriate ways to care for MS patients. Typically, these patients require a wide range of healthcare services throughout their lifetime. Unfortunately, coordination and continuity of this care is often suboptimal.3

The literature has shown that a multidisciplinary team approach is the most effective and efficient way of treating patients with MS.4 This approach to caring for patients with MS facilitates coordination of services and continuity of care, while avoiding duplication and fragmentation for the patient and family.5 By acknowledging the aspects of collaboration inherent in healthcare and striving to improve systems and skills, identification of best practices in multidisciplinary team-based care holds the potential to enhance patient outcomes and possibly help control costs.6-7

This learning initiative will provide guidance to neurologists, primary care professionals, and other allied healthcare professionals, including neuroscience nurses and managed care and specialty pharmacists. The learning initiative will be fulfilled by addressing emerging knowledge about MS pathophysiology and discussing the latest clinical evidence on diagnosis and disease management. This activity is designed to assist healthcare professionals in meeting the challenges they currently face when caring for patients with MS.

Decision Point Question 1
GB is a 57-year-old man whose chief complaint is having trouble walking. He complains of a “pins and needle” sensation in his feet which, in the past 2 to 3 weeks, has made it difficult for him to walk. He also reports difficulty emptying his bladder and a history of optic neuritis, which resolved with corticosteroid treatment. GB’s presentation is consistent with MS but may also suggest other neuromuscular conditions. The clinician needs to probe further.

Which of the following questions would NOT contribute to diagnosing a patient with MS during the patient interview?

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