Diagnosis and Management of Multiple Sclerosis: Case Studies

Multiple sclerosis (MS) is the most common disabling neurologic disease in people ages 18 to 60, second overall only to trauma. This prevalence is more than matched by the complexity of the disease, which is compounded by the dearth of definitive evidence to guide clinical decision making and leaves physicians to rely on their judgment and anecdotal experience. This article attempts to illustrate some of the central questions that arise when confronted with patients who have MS and the thought process that uses available evidence and clinical judgment to resolve these dilemmas. Some of the pertinent questions include: 1. Does this patient actually have MS? 2. Should the patient be treated with disease-modifying therapy? 3. How should the patient who exhibits ongoing disease activity (eg, relapses, progression, or MRI lesions) while on disease-modifying therapy be managed? Patient vignettes are used to illustrate how specific clinical questions may arise, and the subsequent discussions demonstrate how physicians may arrive at a reasonable course of action to manage individual patients effectively. Patient 1dthe clinically isolated syndrome