Abstract
Multiple sclerosis (MS) is a chronic central nervous system inflammatory disease of
autoimmune etiology, mediated by activated T cells with evolving evidence of a significant
contribution from B cells and cells of the innate immune system. The disease is thought
to be due to a complex interaction between different genetic and environmental factors.
The prevalence of MS is rising all over the world, due on one hand to earlier diagnosis
and prolonged survival, and on the other to a true increase in incidence of the disease.
The diagnosis of MS remains clinical despite recent advances in diagnostics and relies
on demonstrating dissemination in space and time while excluding alternative diagnoses.
The Mc Donald diagnostic criteria, with their recent 2017 revision, are currently
widely accepted in the MS community. Although no cure is yet available, many disease-modifying
therapies (DMTs) have shown different levels of efficacy in preventing relapses, accumulation
of lesions on magnetic resonance imaging (MRI), and disability progression. Current
treatment strategies include gradual escalation based on clinical and radiological
criteria that determine treatment response, or initial induction with high efficacy
DMTs especially in patients with an early aggressive course.
Keywords
multiple sclerosis - review - treatment guidelines - diagnosis
