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http://crossmark.crossref.org/dialog/?doi=10.1007/s11910-016-0688-8&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s11910-016-0688-8&domain=pdf
Web End = Curr Neurol Neurosci Rep (2016) 16: 90
DOI 10.1007/s11910-016-0688-8
DEMYELINATING DISORDERS (DN BOURDETTE AND M CAMERON, SECTION EDITORS)
Diagnostic Criteria, Classification and Treatment Goals in Multiple Sclerosis: The Chronicles of Time and Space
Achilles Ntranos1 & Fred Lublin1,2
Published online: 22 August 2016# Springer Science+Business Media New York 2016
Abstract Multiple sclerosis (MS) is one of the most diverse human diseases. Since its first description by Charcot in the nineteenth century, the diagnostic criteria, clinical course classification, and treatment goals for MS have been constantly revised and updated to improve diagnostic accuracy, physician communication, and clinical trial design. These changes have improved the clinical outcomes and quality of life for patients with the disease. Recent technological and research breakthroughs will almost certainly further change how we diagnose, classify, and treat MS in the future. In this review, we summarize the key events in the history of MS, explain the reasoning behind the current criteria for MS diagnosis, classification, and treatment, and provide suggestions for further improvements that will keep enhancing the clinical practice of MS.
Keywords Multiple sclerosis . Early diagnosis . History . Clinical decision-making . Therapeutics . Patient care
Introduction
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system that is the most common cause of non-traumatic disability in young adults. MS patho-physiology is characterized by acute demyelinating attacks, axonal injury [1], inefficient remyelination [2], mitochondrial dysfunction, and progressive neurodegeneration [3, 4]. This makes it one of the most diverse human diseases with an unpredictable clinical presentation and highly variable course [5]. In all of its complexity, diagnosing MS can be an easy task in the correct clinical setting, but it can also be one of the most challenging clinical puzzles a physician can face nowadays.
Since the description of MS by Charcot in the nineteenth century, there has been an increasingly important need to accurately diagnose MS with minimal diagnostic variability and error, as well as to better classify its clinical course. Nowadays, this need is more important than ever, as the advent of more effective disease-modifying drugs was accompanied by an increased risk of significant to life-threatening side effects [6]. Moreover, advancing MS therapeutics in the future may...