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      An Overview of the History, Pathophysiology, and Pharmacological Interventions of Multiple Sclerosis

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          Abstract

          Multiple sclerosis (MS) is an immune-inflammatory disease that attacks and damages myelinated axons in the central nervous system (CNS) and causes nontraumatic neurological impairment in young people. Historically, Lidwina of Schiedam documented the first MS case. After that, Augustus d'Este wrote for years about how his MS symptoms worsened. Age, sex, genetics, environment, smoking, injuries, and infections, including herpes simplex and rabies, are risk factors for MS. According to epidemiology, the average age of onset is between 20 and 40 years. MS is more prevalent in women and is common in Europe and America. As diagnostic methods and criteria change, people with MS may be discovered at earlier and earlier stages of the disease. MS therapy has advanced dramatically due to breakthroughs in our knowledge of the disease's etiology and progression. Therefore, the efficacy and risk of treatment medications increased exponentially. Management goals include reducing lesion activity and avoiding secondary progression. Current treatment approaches focus on managing acute episodes, relieving symptoms, and reducing biological activity. Disease-modifying drugs such as fingolimod, interferon-beta, natalizumab, and dimethyl fumarate are the most widely used treatments for MS. For proof of the efficacy and safety of these medications, investigations in the real world are necessary.

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          Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

          The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.
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            Defining the clinical course of multiple sclerosis

            Accurate clinical course descriptions (phenotypes) of multiple sclerosis (MS) are important for communication, prognostication, design and recruitment of clinical trials, and treatment decision-making. Standardized descriptions published in 1996 based on a survey of international MS experts provided purely clinical phenotypes based on data and consensus at that time, but imaging and biological correlates were lacking. Increased understanding of MS and its pathology, coupled with general concern that the original descriptors may not adequately reflect more recently identified clinical aspects of the disease, prompted a re-examination of MS disease phenotypes by the International Advisory Committee on Clinical Trials of MS. While imaging and biological markers that might provide objective criteria for separating clinical phenotypes are lacking, we propose refined descriptors that include consideration of disease activity (based on clinical relapse rate and imaging findings) and disease progression. Strategies for future research to better define phenotypes are also outlined.
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              Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

              B cells influence the pathogenesis of multiple sclerosis. Ocrelizumab is a humanized monoclonal antibody that selectively depletes CD20+ B cells.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                2 January 2023
                January 2023
                : 15
                : 1
                : e33242
                Affiliations
                [1 ] Department of Pharmacy, King Abdulaziz Specialist Hospital, Taif, SAU
                [2 ] Department of Medicine, PHC Al-Qassim Health Cluster, Buraidah, SAU
                [3 ] Department of Pharmacy, Maternity and Children Hospital, Dammam, SAU
                [4 ] Department of Pharmacy, Armed Forces Hospital, Jazan, SAU
                [5 ] Department of Pharmacy, Al Thaghr Hospital, Jeddah, SAU
                [6 ] Faculty of Pharmacy, University of Shaqra, Al-Dawadmi, SAU
                [7 ] Faculty of Pharmacy, Umm Al Qura University, Mecca, SAU
                [8 ] Faculty of Pharmacy, Northern Border University, Rafha, SAU
                [9 ] Faculty of Pharmacy, Buraydah College, Al-Qassim, SAU
                [10 ] Department of Pharmacy, Taif University, Taif, SAU
                [11 ] Department of Pharmacy, Community Pharmacy, Riyadh, SAU
                Author notes
                Article
                10.7759/cureus.33242
                9888604
                36733554
                ba5080c4-75da-468b-9a3f-cc03c5733811
                Copyright © 2023, Dighriri et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 January 2023
                Categories
                Neurology
                Pathology
                Allergy/Immunology

                cns,pathogenesis,disease-modifying therapies,ms,multiple sclerosis

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