title: Multiple sclerosis: a primary care perspective.
abstract: Multiple sclerosis (MS) is the most common permanently disabling disorder of the central nervous system in young adults. Relapsing remitting MS is the most common type, and typical symptoms include sensory disturbances, Lhermitte sign, motor weakness, optic neuritis, impaired coordination, and fatigue. The course of disease is highly variable. The diagnosis is clinical and involves two neurologic deficits or objective attacks separated in time and space. Magnetic resonance imaging is helpful in confirming the diagnosis and excluding mimics. Symptom exacerbations affect 85% of patients with MS. Corticosteroids are the treatment of choice for patients with acute, significant symptoms. Disease-modifying agents should be initiated early in the treatment of MS to forestall disease and preserve function. Two immunomodulatory agents (interferon beta and glatiramer) and five immunosuppressive agents (fingolimod, teriflunomide, dimethyl fumarate, natalizumab, and mitoxantrone) are approved by the U.S. Food and Drug Administration for the treatment of MS, each with demonstrated effectiveness and unique adverse effect profiles. Symptom management constitutes a large part of care; neurogenic bladder and bowel, sexual dysfunction, pain, spasticity, and fatigue are best treated with a multidisciplinary approach to improve quality of life.
authors.affiliation: Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Saguil
authors.affiliation: Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Kane
authors.affiliation: Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.
authors.forename: Edwin
authors.initials: E
authors.lastname: Farnell
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D017281:Cost of Illness; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D011788:Quality of Life; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology; D018434:Sickness Impact Profile; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007155:Immunologic Factors; D007166:Immunosuppressive Agents