title: Brain health: time matters in multiple sclerosis.
abstract: BACKGROUND
  We present international consensus recommendations for improving diagnosis, management and treatment access in multiple sclerosis (MS). Our vision is that these will be used widely among those committed to creating a better future for people with MS and their families.
  
  
  METHODS
  Structured discussions and literature searches conducted in 2015 examined the personal and economic impact of MS, current practice in diagnosis, treatment and management, definitions of disease activity and barriers to accessing disease-modifying therapies (DMTs).
  
  
  RESULTS
  Delays often occur before a person with symptoms suggestive of MS sees a neurologist. Campaigns to raise awareness of MS are needed, as are initiatives to improve access to MS healthcare professionals and services. We recommend a clear treatment goal: to maximize neurological reserve, cognitive function and physical function by reducing disease activity. Treatment should start early, with DMT and lifestyle measures. All parameters that predict relapses and disability progression should be included in the definition of disease activity and monitored regularly when practical. On suboptimal control of disease activity, switching to a DMT with a different mechanism of action should be considered. A shared decision-making process that embodies dialogue and considers all appropriate DMTs should be implemented. Monitoring data should be recorded formally in registries to generate real-world evidence. In many jurisdictions, access to DMTs is limited. To improve treatment access the relevant bodies should consider all costs to all parties when conducting economic evaluations and encourage the continuing investigation, development and use of cost-effective therapeutic strategies and alternative financing models.
  
  
  CONCLUSIONS
  The consensus findings of an international author group recommend a therapeutic strategy based on proactive monitoring and shared decision-making in MS. Early diagnosis and improved treatment access are also key components.
authors.affiliation: Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK. Electronic address: g.giovannoni@qmul.ac.uk.
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovannoni
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. Electronic address: butz@unimelb.edu.au.
authors.forename: Helmut
authors.initials: H
authors.lastname: Butzkueven
authors.affiliation: Department of Neurology, RUTGERS-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: jalbutsu@rwjms.rutgers.edu.
authors.forename: Suhayl
authors.initials: S
authors.lastname: Dhib-Jalbut
authors.affiliation: Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK. Electronic address: jeremy.hobart@plymouth.ac.uk.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hobart
authors.affiliation: European Health Economics, Mulhouse, France. Electronic address: kobelt.gisele@wanadoo.fr.
authors.forename: Gisela
authors.initials: G
authors.lastname: Kobelt
authors.affiliation: Shift.ms, Leeds, UK. Electronic address: george@shift.ms.
authors.forename: George
authors.initials: G
authors.lastname: Pepper
authors.affiliation: Biostatistics Unit, University of Genoa, Genoa, Italy. Electronic address: mariapia.sormani@unige.it.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.affiliation: Patient Advocate in Multiple Sclerosis, Brussels, Belgium. Electronic address: christoph.thalheim@emsp.org.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thalheim
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: t.traboulsee@ubc.ca.
authors.forename: Anthony
authors.initials: A
authors.lastname: Traboulsee
authors.affiliation: Department of Neurology, University of Colorado Denver, Aurora, CO, USA. Electronic address: Timothy.Vollmer@ucdenver.edu.
authors.forename: Timothy
authors.initials: T
authors.lastname: Vollmer
mesh_terms: D001921:Brain / Q000503:physiopathology*; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors
keywords: Consensus statement; Disease activity; Disease-modifying therapy (DMT); Magnetic resonance imaging (MRI); Multiple sclerosis; Treatment strategy