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NEUROLOGY IN PRACTICE: MULTIPLE SCLEROSIS
  1. G N Fuller,
  2. I Bone
  1. Dr GN Fuller, Department of Neurology, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK geraint{at}fullerg.demon.co.uk

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Multiple sclerosis is a common disabling neurological disorder. The neurologist is involved in the diagnosis of multiple sclerosis, and of necessity in considering its differential diagnosis. Jackie Palace considers how to make the diagnosis and Neil Scolding considers the differential diagnosis. Dr Palace discusses how to manage the difficult process of informing the patient of the diagnosis. This discussion inevitably involves some exploration and prediction of what the future will hold; George Ebers provides a discussion of what is known of the prognosis of multiple sclerosis. We have not provided a detailed discussion of disease modulating drugs, as this is widely discussed elsewhere, but provide the references to the main trials. An important role of the neurologist is in advising on the management of symptoms in patients with established multiple sclerosis. Alan Thompson discusses the opportunities, and limitations, for symptom management.

Many of the key references about multiple sclerosis are cited in the articles that follow. Here we highlight a few of the most useful and important sources.

KEY REFERENCES

  • McAlpine's multiple sclerosis, 3rd ed. Compston A, Ebers G, Lassman H, et al. Churchill Livingstone, 1998.

Currently the definitive account of multiple sclerosis.

REVIEWS

  • Diagnosis of multiple sclerosis. Paty DW, Noseworthy JH, Ebers GC. In: Paty DW, Ebers GC, eds. Multiple sclerosis. Contemporary Neurology Series, FA Davis, 1998.

A comprehensive review of the whole subject of the diagnosis of MS from the ways it presents, the investigations, through to explaining the diagnosis to the patient. A lot of work has gone into combining information from previous studies on virtually every aspect of this subject to produce some very useful and interesting tables not available elsewhere.

  • Primary progressive multiple sclerosis. Thompson AJ, Polnam CH, Miller DH, et al. Primary progressive multiple sclerosis. Brain 1997;120:1085–96.

An excellent overview of primary progressive multiple sclerosis including the diagnostic criteria (not well covered by the Poser criteria), differential diagnoses, the clinical, pathological, and investigational features, and highlighting differences with secondary progressive disease.

DIAGNOSTIC GUIDELINES

  • New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Poser CM, Paty DW, Scheinberg L, et al. Ann Neurol 1983;13:227–31.

The standard diagnostic criteria for multiple sclerosis used in most recent trials.

  • Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. McDonald WI, Compston A, Edan G, et al. Ann Neurol 2001;50:121–7.

New guidelines for the diagnosis of multiple sclerosis.

GUIDELINES/STANDARDS OF CARE

  • Guidelines for the use of beta interferon in multiple sclerosis. Association of British Neurologists, 1999

  • Basics of best practice in the management of multiple sclerosis. Multiple Sclerosis Society of Great Britain and Northern Ireland, 1999

  • Scottish Needs Assessment Programme (SNAP): multiple sclerosis. Office for Public Health in Scotland, 2000.

MULTIPLE SCLEROSIS SOCIETY RECOMMENDATIONS

Suggested reading from the patient and healthcare standards perspectives.

  • A dispatch from the frontline: the views of people with multiple sclerosis about their needs. A qualitative approach. Robinson I, Hunter M, Neilson S. Brunel MS Research Unit 1996. (Commissioned by and available from the MS Society.)

  • Views from the other side: everyday perspectives on living and working with people with MS by those concerned with their informal and formal (health) care. A qualitative approach. Robinson I, Hunter M. Brunel MS Research Unit 1998. (Commissioned by and available from the MS Society.)

  • Standards of Healthcare for people with MS. Freeman J, Thompson J, Rollinson S, et al. 1997. A joint publication by the MS Society and the National Hospital for Neurology and Neurosurgery.

  • MS Society symptom management survey, 1997

COCHRANE CORNER

From Cochrane database of systematic reviews, first quarter 2001

  • Prostaglandin E1 for the treatment of erectile dysfunction in patients with multiple sclerosis. Urciuoli R, Giuglietti M, Carlini M, Botti F.

  • Mitoxantrone for secondary progressive and progressive relapsing multiple sclerosis. Filippi M, Martinelli-Boneschi F, Comi G, Rovaris M.

  • Intravenous immunoglobulins for multiple sclerosis. Forbes R, McDonnell G, Gray O.

  • Interferon in relapsing-remitting multiple sclerosis. Rice G, Filippini G, Polman C, Ebers G, Incorvaia B, Munari L.

  • Cyclophosphamide for multiple sclerosis. La Mantia L, Milanese C, D'Amico R, Van Veen T, Weinstock-Guttman B.

  • Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Filippini G, Brusaferri F, Sibley W, Citterio A, Ciucci G, Midgard R, Candelise L.

  • Anti-spasticity drug for multiple sclerosis. Shakespeare D, Boggild M, Young C.

  • Aminopyridines for symptomatic treatment in multiple sclerosis. Solari A, Uitdehaag B, Giuliani G, Pucci E, Taus C.

  • Amantidine for fatigue in multiple sclerosis. Taus C, Giuliani G, Pucci E, Solari A, Hyde C, Branas P.

Other useful Cochrane resources

  • Corticosteroids for optic neuritis. Beck R, Gal R, Henshaw K. (Cochrane Eyes and Vision Group).

  • Antidepressants for depression in people with physical illness. Gill D, Hatcher S. (Cochrane Depression, Anxiety and Neurosis Group)

  • Anticonvulsant drugs for acute and chronic pain. Wiffen P, Collins S, McQuay H, Carroll D, Jadad A, Moore A. (Cochrane Pain, Palliative Care and Supportive Care Group).

Clinical Evidence (issue 5)

  • Neurological disorders: multiple sclerosis. Ford H, Boggild M. BMJ Publishing Group, June 2001 (search date May 2000)

This helpful overview addresses the best available evidence for disease modifying treatments, management of acute relapse, fatigue, spasticity, and the effects of multidisciplinary models of care.

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