With multiple sclerosis (MS) affecting women two to three times more often than men, and an average age of onset of 20–50 years, a good portion of MS patients will be women of reproductive potential. Therefore, it is critical to develop an understanding of how the disease affects reproduction and menopause, and how it might impact their life goals. Over the course of this chapter, epidemiological risk factors based on gender, pregnancy, and the need for family planning will be reviewed.

With the ongoing expansion of the therapeutic armamentarium, treatment strategies for multiple sclerosis (MS) have undergone profound changes in the last few years. Several treatment options are available at this time, and the effects of these drugs appear to be greater when treatment is initiated early, soon after the onset of symptoms. This chapter reviews currently used disease-modifying agents (Figure 7.1) in addition to several promising therapies in various phases of development.

NMSS provides information for newly diagnosed individuals and their physicians, treatment options, webcasts, details on current research, and links to local chapters and providers.

The pattern and course of multiple sclerosis (MS) are categorized into several clinical subtypes (Figure 3.1).

Despite recent refinements in the diagnostic criteria, multiple sclerosis (MS) remains a challenging diagnosis. Several acquired and inherited disorders can mimic MS both clinically and radiographically, which may further complicate the diagnostic process. This chapter focuses on the most common diseases that mimic MS (“MS mimics”), the most relevant clinical and diagnostic characteristics suggestive of an alternative diagnosis, and the best diagnostic workup for the exclusion of similar conditions. A discussion of specific magnetic resonance imaging (MRI) features that may help distinguish MS from its mimics is presented in Chapter 6.

Symptoms of multiple sclerosis (MS) vary considerably from person to person and change over time. Most of these symptoms can be alleviated, but very few can be eliminated completely. Not all symptoms associated with MS are directly related to inflammation of the central nervous system. Although treatment of the disease itself is of major importance, treatment of secondary symptoms is equally important, as failure to do so can compromise quality of life for both patients and their families. In this chapter, we discuss the most common MS-related symptoms and their management. It is important to keep in mind that all treatments used have the potential for side effects. For some symptoms, nondrug approaches are the best initial approach to treatment. Potential difficulties associated with some forms of treatment are also discussed.

Although a diagnosis of multiple sclerosis (MS) is mostly made on clinical grounds, laboratory tests and imaging of the central nervous system (CNS) also play important roles in supporting a diagnosis. The value of magnetic resonance imaging (MRI) in the diagnosis of MS is discussed in this chapter.

Multiple sclerosis (MS) is a chronic, immune-mediated, inflammatory/demyelinating disease of the central nervous system (CNS).1 Although certain clinical features are characteristic of MS, its manifestations can be highly variable among patients.2 This chapter discusses the diagnostic approach and clinical features of MS, as well as specific features (red flags) that should alert the clinician to the possibility of diseases other than MS (“MS mimics”).

The goals of treatment in multiple sclerosis (MS) have evolved greatly over the past few decades. The original natural history of MS cohorts described in Olmsted County, Minnesota, and in Lyon, France, suggested that MS patients became disabled around the same age regardless of treatment.1,2 Therefore, even after the development of disease-modifying therapies (DMTs), the concept of medical futility remained in the field.

The primary role of the neurologist in the emergency department (ED) when confronted with a potential exacerbation of a neuroimmunologic condition is first, to rule out potential “mimics,” and second, to treat acute episodes of true neurologic dysfunction.

Recognition and diagnosis of pediatric multiple sclerosis (MS) can be challenging given the broad differential of possible MS mimics and acquired demyelinating syndrome (ADS) phenotypes. It is not uncommon for clinicians to consider alternative diagnoses rather than MS in children with acute neurologic symptoms and white matter lesions on MRI, such as leukodystrophies, vasculopathies, mitochondrial defects, or other metabolic or inflammatory disorders. Once a diagnosis is made, the current lack of understanding regarding the safety and generalizability of use of disease-modifying therapy (DMT) in children can pose additional challenges to treating children and adolescents. In this chapter, we discuss the clinical presentation, diagnostic evaluation, and treatment approach to pediatric-onset MS, paying special attention to the areas in which pediatric disease may differ from adult-onset MS.