Multiple Sclerosis: Contemporary Issues in the Care Continuum

The diagnosis and management of MS continue to evolve, and people with multiple sclerosis (PwMS) are crucial to what we, as healthcare professionals, do. The editorial team and I are very excited to share this issue of Practical Neurology focusing on contemporary and practical aspects in the management of MS. This issue is unique in that each article is a product of collaborative effort between mentors and their mentees.

The issue starts with practical aspects of managing MS relapses, written by Drs. Thompson, Arcot Jayagopal, and Zabad. Interestingly, managing MS relapses has remained the same over the past many years, as the authors highlight in their analysis of historical and contemporary relapse management. The article provides excellent practical points on managing relapses and a table summary comparing steroids and other approaches to MS relapse management. The next article by Drs. Elfasi, Krett, Lindgren, and Newsome provides practical aspects for safety monitoring of the wide array of disease-modifying therapies (DMTs). Compared with options for relapse management, DMTs have rapidly evolved over the past decade, requiring the clinician to become familiar with the nuances of each DMT and their monitoring requirements. This article is an outstanding read and is organized into sections based on the DMT proposed mechanism of action. The authors provide a very informative table summarizing baseline and monitoring recommendations for each DMT to help the clinician ensure appropriate monitoring and safe administration.

To continue with the contemporary issues on MS, Drs. Moehlman, Upchurch, Wade, and Shah focus on practical considerations for family planning in MS. It is important to have a dialogue with PwMS on their considerations for family planning. The authors provide excellent and practical advice on how to approach family planning and the importance of discussing PwMS’s wishes about family planning; two tables summarize data along with practical recommendations surrounding family planning and breastfeeding in PwMS.

Next, Drs. Johnson, SJ Hooshmand, and SI Hooshmand discuss fatigue management in MS, the most reported symptom experienced by PwMS. This article provides an excellent review of the diagnostics needed when evaluating MS fatigue and pharmacological and non-pharmacological management approaches. Don’t forget to check out the new mnemonic “P.I.A.N.I.S.T” that can help us recall what needs to be done for secondary MS fatigue. Following on symptomatic management in MS, the next article discusses practical aspects of identifying, managing, and preventing polypharmacy in MS. Here, medical student Lauren, nurse practitioner Kaylan, and I provide a practical approach that clinicians can use to identify and prevent polypharmacy in MS, and we further highlight non-pharmacological interventions for common MS symptoms.

Next, we learn about radiologically isolated syndrome (RIS), a recently described entity on the MS continuum. Drs. Morgan and Longbrake provide practical considerations on the current diagnosis and treatment of RIS along with future perspectives. Further, the authors discuss the importance of carefully considering risks and potential benefits when considering DMTs for RIS, as they discuss the recent clinical trials completed for RIS.

Finally, in a bonus article available online at practicalneurology.com, Sophie Zacharek, and Drs. Yang and Graves provide an excellent overview of the opportunities for treating children with MS with highly effective DMTs, and they further discuss challenges in both clinical practice and clinical trials.

I hope you enjoy this unique issue and apply many of the principles and recommendations discussed by the group of MS experts and their trainees in your daily clinical practice.