TY - JOUR T1 - Time matters in multiple sclerosis: can early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis? JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 844 LP - 850 DO - 10.1136/jnnp-2017-317509 VL - 89 IS - 8 AU - João J Cerqueira AU - D Alastair S Compston AU - Ruth Geraldes AU - Mario M Rosa AU - Klaus Schmierer AU - Alan Thompson AU - Michela Tinelli AU - Jacqueline Palace Y1 - 2018/08/01 UR - http://jnnp.bmj.com/content/89/8/844.abstract N2 - The management of multiple sclerosis (MS) has been a neurology success story for the past 25 years. Advances in understanding of the disease mechanisms and the dynamic nature of the disease have brought around 12 disease-modifying therapies (DMTs) to market in many countries.However, treatment is hampered by adverse effects and by limited evidence of efficacy in more advanced ‘progressive’ MS. Some patients do not receive DMTs for years after diagnosis, or are told medication can no longer help as their disability is worsening. The cost of DMTs is also a significant issue, especially in low-income and middle-income countries.MS affects an estimated 2.5 million people worldwide, with a higher prevalence and incidence in the northern hemisphere.1 Patients with MS now have a longer life expectancy,2 3 in part because of earlier treatment. Accounting for comorbidities such as age-related vascular disease will become increasingly important in patient management.4The Journal of Neurology, Neurosurgery & Psychiatry brought together a panel of experts on World MS Day 2017 to discuss the importance of time in MS—timing of initiation and withdrawal of disease-modifying treatment, time to consider contributory factors such as vascular disease, and the time and cost burden of MS. This paper, which originated in the round table discussion, reviews the following:latest thinking in timing of disease managementhow treatment and prevention of vascular injury may buy additional time for people with MSnew data about the true economic and social burden of the disease for people with MS and their carers.MS damages the whole brain, and damage begins from the start of the disease. Every system in the brain—myelin, white matter, neurones, axons and blood vessels—is damaged by MS.5–7 Brain atrophy, both in the cortex and the white matter, is progressive and accelerates over time.8 Evidence … ER -