title: Consensus recommendations for the diagnosis and treatment of multiple sclerosis in Kuwait.
abstract: OBJECTIVE
  We aim to develop consensus recommendations to guide neurologists in the community for the diagnosis and treatment of Multiple Sclerosis (MS).
  
  
  METHODS
  After reviewing the available literature, a group of neurologists with expertise in MS met to discuss the evidence and develop consensus recommendations for the diagnosis and treatment of MS.
  
  
  RESULTS
  The revised 2010 McDonald criteria is the established diagnostic criteria for MS and has wide international acceptance among international MS experts. Several red flags in the history and examination, along with certain laboratory tests were pointed out to exclude MS mimickers in the diagnostic phase. The available approved disease modifying therapies (DMTs) were listed in an algorithmic fashion based on initial assessment of disease severity and subsequent disease breakthrough while on DMTs. Risk stratification based on the benefit versus risk ratio was used to help choosing the appropriate therapy to MS patients using an "individualized therapy" approach. The requirements for initiation and monitoring of treated MS patients were highlighted with emphasis on early identification of disease breakthrough, adverse events, and safety concerns. The role of multi-disciplinary MS clinics was discussed and a guide for referral to specialized MS clinics was developed.
  
  
  CONCLUSIONS
  Consensus recommendations have been developed to guide local neurologists on the diagnosis and treatment of patients with MS. Implementation of the revised 2010 McDonald diagnostic criteria was advised while a personalized treatment approach was recommended using a treatment algorithm based on risk stratification and patient-centered outcomes.
authors.affiliation: Division of Neurology, Department of Medicine, Amiri hospital, Kuwait; Neurology Clinic, Dasman Diabetes Institute, Kuwait. Electronic address: alroughani@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: Division of Neurology, Department of Medicine, Amiri hospital, Kuwait.
authors.forename: A
authors.initials: A
authors.lastname: Ashkanani
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait; Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: J
authors.initials: J
authors.lastname: Al-Hashel
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait.
authors.forename: R
authors.initials: R
authors.lastname: Khan
authors.affiliation: Division of Neurology, Department of Medicine, Amiri hospital, Kuwait; Neurology Clinic, Dasman Diabetes Institute, Kuwait.
authors.forename: A
authors.initials: A
authors.lastname: Thussu
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait.
authors.forename: K J
authors.initials: KJ
authors.lastname: Alexander
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait.
authors.forename: P
authors.initials: P
authors.lastname: Vembu
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait.
authors.forename: K
authors.initials: K
authors.lastname: Sharfuddin
authors.affiliation: Division of Neurology, Department of Medicine, Amiri hospital, Kuwait.
authors.forename: S
authors.initials: S
authors.lastname: Lamdhade
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait.
authors.forename: J K
authors.initials: JK
authors.lastname: John
authors.affiliation: Division of Neurology, Department of medicine, Farwaniya Hospital, Kuwait.
authors.forename: S
authors.initials: S
authors.lastname: Alkhashan
authors.affiliation: Division of Neurology, Department of medicine, Al-Adan Hospital, Kuwait.
authors.forename: M
authors.initials: M
authors.lastname: Abualmelh
authors.affiliation: Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait; Division of Neurology, Department of medicine, Mubarak Al-Kabeer Hospital, Kuwait.
authors.forename: S
authors.initials: S
authors.lastname: Al-Shammri
mesh_terms: D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007730:Kuwait / Q000453:epidemiology; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D000072141:Neurologists / Q000592:standards; D010348:Patient Care Team / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Diagnosis; Multiple sclerosis; Recommendations; Risk stratification; Treatment