title: Intervening to reduce the risk of future disability from multiple sclerosis: are we there yet?
abstract: Disease-modifying therapies (DMTs) delay or may prevent the progression of patients with high-risk clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (MS), and from relapsing-remitting MS to secondary progressive MS. Current evidence on the effects of DMT on disability in MS is supported by the use of the Expanded Disability Status Scale (EDSS), which is dominated by ambulation, and usually used as a secondary outcome measure. Less is known about the long-term effects of DMTs on other aspects of functional status, particularly cognition, which is a key determinant of ability to work. The time scale for measurements of disability is at most a few years, with scant data from more than 10 years of observation. Longer prospective follow-up of large numbers of patients with CIS is needed to determine whether early intervention with a DMT influences long-term disease progression. Finally, the emergence of the radiologically isolated syndrome (RIS) as a clinical entity has shifted the debate about when to intervene to an even earlier time frame. Balancing the significant side-effects associated with DMT in general and the expected outcome of pharmacologic intervention is increasingly problematic for managing patients with uncertain prognosis, as many patients may have low-risk CIS, benign MS or patients with RIS only. Preventing long-term disability in MS should be recognised more clearly as an important outcome in its own right, with disability measured more consistently with more sensitive instruments beyond the use of the EDSS.
authors.affiliation: a Department of Internal Medicine, Neurology Section , Arab Medical Center and Khalidi Hospital , Amman , Jordan.
authors.forename: Maurice
authors.initials: M
authors.lastname: Dahdaleh
authors.affiliation: b Division of Neurology, Amiri Hospital, Kuwait and Division of Neurology , Dasman Diabetes Institute , Kuwait City , Kuwait.
authors.forename: Raed
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: c King Abdullah International Medical Research Center , King Saud Ben Abdulaziz University for Health Sciences, NGHA , Riyadh , Saudi Arabia.|d KFMC, Ministry of Health , Riyadh , Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aljumah
authors.affiliation: e Neurology Section , King Khalid University Hospital, King Saud University and Dallah Hospital , Riyadh , Saudi Arabia.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: AlTahan
authors.affiliation: f Clinical Neurosciences Department , Salmaniya Medical Complex , Manama , Bahrain.
authors.forename: Issa
authors.initials: I
authors.lastname: Alsharoqi
authors.affiliation: g Department of Neurosciences , King Faisal Specialist Hospital and Research Centre , Riyadh , Saudi Arabia.
authors.forename: Saeed A
authors.initials: SA
authors.lastname: Bohlega
authors.affiliation: h Neurology Division, King Khalid University Hospital , King Saud University , Riyadh , Saudi Arabia.
authors.forename: Abdulkader
authors.initials: A
authors.lastname: Daif
authors.affiliation: i Department of Neurology (Medicine) , Hamad Medical Corporation , Doha , Qatar.
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.affiliation: j Neurology Department, Rashid Hospital and Dubai Medical College , Dubai Health Authority , Dubai , United Arab Emirates.
authors.forename: Jihad
authors.initials: J
authors.lastname: Inshasi
authors.affiliation: k Department of Neurology, Neuroimmunology Unit , Hacettepe University Hospitals , Ankara , Turkey.
authors.forename: Rana
authors.initials: R
authors.lastname: Karabudak
authors.affiliation: l MS Research Center , Neuroscience Institute, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Sahraian
authors.affiliation: m Merck Serono Intercontinental Region , Dubai , United Arab Emirates.
authors.forename: Karim
authors.initials: K
authors.lastname: Taha
authors.affiliation: n Multiple Sclerosis Center , American University of Beirut Medical Center , Beirut , Lebanon.
authors.forename: Bassem I
authors.initials: BI
authors.lastname: Yammout
authors.affiliation: o Neuropsychiatric Department, Faculty of Medicine , Ain Shams University , Egypt.
authors.forename: Magd
authors.initials: M
authors.lastname: Zakaria
mesh_terms: D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents
keywords: Multiple sclerosis; clinical isolated syndrome; disability; disease-modifying therapy; radiologically isolated syndrome