title: Practical consultations: multiple sclerosis.
abstract: People with multiple sclerosis (MS) are increasingly referred for specialty care to tertiary centers, particularly for advice regarding initiation and monitoring of immunomodulatory therapies. However, the generalist must still be able to apply appropriate skills and technology to diagnose the disease and its complications, provide basic counseling of patients, and be aware of potential treatment options at the time of diagnosis and when therapeutic regimens fail. A general approach, supported by evidence where possible, to common and contemporary clinical issues in MS care is provided in a case-based narrative.
authors.affiliation: Multiple Sclerosis Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Carter
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D003711:Demyelinating Diseases; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D015507:Drugs, Investigational; D019317:Evidence-Based Medicine; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D016899:Interferon-beta / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000145:classification / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy*; D011247:Pregnancy; D012017:Referral and Consultation; D017211:Treatment Failure
chemical_list: D000276:Adjuvants, Immunologic; D015507:Drugs, Investigational; D016899:Interferon-beta