Timely and accurate diagnosis of demyelinating central nervous system diseases like multiple sclerosis is of paramount importance and has a huge bearing on patients’ outcomes and their ensuing quality of life. Considerable effort has been placed on the diagnostic process and formal guidelines has been developed. Nevertheless, the diagnosis of multiple sclerosis is predominantly based on history, clinical manifestations, laboratory studies, and imaging. The enigmatic nature of Multiple Sclerosis coupled with the poor understanding of its pathophysiology has limited diagnostic and treatment advances. There is currently no definitive diagnostic test to recognize the disease. Evolution of Multiple Sclerosis Diagnosis In 1868, a French neurologist Jean-Martin Charcot, described clinical features typical for multiple sclerosis as telegraphic (scanning) speech, nystagmus and intention tremor in what became known as Charcot’s triad. Although this triad was said to be characteristic of multiple sclerosis, it typically occurred in very advanced disease and was akin to other neurological disorders that involved damage to the cerebellum. In 1906, an Austrian neurologist Otto Marburg affirmed that a lack of the plantar reflex, observation of Uhthoff’s sign (temporary deterioration of neurological symptoms attributed to a rise in the body’s core temperature) and pyramidal signs were sufficient to diagnose multiple sclerosis.

Multiple sclerosis is a lifelong disease that requires various modalities of treatment. Plan of care considerations include (1) the patient’s age at onset of illness; (2) sex; (3) the extent of the disability at the time of diagnosis as well as (4) the form of multiple sclerosis. Treatment will be a multidisciplinary approach that involves specialists such as neurologists, rehabilitation specialists, neuro-urology experts, psychiatrists, occupational therapists, physiotherapists and social workers. This method is essential to ensure that all aspects of the disease are considered to help improve their quality of life. The management of multiple sclerosis consists of a four-prong approach that involves: (1) management of acute exacerbations; (2) reduction of the frequency of relapses; (3) administration of the complications and (4) management of permanent disability that has already occurred.  These are the goals of the management. No cure for the disease has been established. Management of Acute Exacerbations (index demyelinating episodes) High-dose steroids such as corticosteroids are the cornerstone of treating acute exacerbations because they reduce and control inflammation. Steroids are generally reserved for patients with exacerbations severe enough to cause functional disability or in those that exacerbations are prolonged beyond the duration of 24 hours. Corticosteroids work by reducing the inflammation which is a primary cause of the systems of multiple sclerosis.

Multiple sclerosis affects all aspects of the patient’s lives and can significantly reduce their quality of life. The complications that result from multiple sclerosis are multi-systemic. Multiple Sclerosis Complications include: Intractable tremors. Depression Muscle spasms. Heat sensitivity Chronic pain. Sexual dysfunction Bladder dysfunction. Fatigue Urinary Tract Infections.Cognitive deficits Constipation/ Fecal incontinence Here, we will briefly discuss the pharmacological and non-pharmacological management of each of them. Intractable tremors: are a common symptom in MS patients. They can be managed by use of devices like weights on the hands, deep brain stimulation, or surgery of the Thalamus in the brain. Pharmacotherapy includes the use of anticonvulsants like Clonazepam. Other drugs that have been used are Mysoline, Ondansetron, and Propranolol. Muscle spasms: may also be present and are treated by encouraging the patients to participate in exercise and stretching regularly. Other treatments such as physiotherapy and occupational therapy have been shown to be of benefit. Drugs used to reduce spasticity include Diazepam (Valium), Baclofen, Dantrolene, and Tizanidine. These are skeletal muscle relaxing agents. Pain: is another primary symptom MS patients will experience over a prolonged period. It is managed using anticonvulsants, tricyclic antidepressants, and anti-arrhythmic agents. These include agents like gabapentin, phenytoin and carbamazepine 100 -1000 milligrams per day.

With new cutting-edge technology such as gene-chip technology and new MRI-based advancements, the boundaries of multiple sclerosis as we know them today are being stretched to the limit. Numerous research activities directed at understanding its etiopathogenesis, halting its progression, restoring lost function, and development of a cure are underway with new strides being made every day. Major clinical trials are underway testing novel ways of treating multiple sclerosis with several drugs in advanced phases. Laquinimod is an experimental immunomodulatory that alters T-cell populations to promote regulatory T-cell activity instead of the attack-focused Th1 response and also seems to play a role in the synthesis of neuroprotective molecules. Developed by Active Biotech and Teva, it is being investigated as an option for management of some forms of multiple sclerosis. Teriflunomide, the active metabolite of leflunomide, is another immunomodulator under investigation for the treatment of multiple sclerosis. The proposed mechanism of action of teriflunomide is the blockade of pyrimidine synthesis that exerts a cytostatic effect on proliferating lymphocytes. Other drugs under investigation for the treatment of multiple sclerosis include BG-12 (dimethyl fumarate), daclizumab (Zena pax), Alemtuzumab (Campath/Lemtrada), Rituximab (Rituxan), Ocrelizumab and Ibudilast. New studies have shed more light on the role of lifestyle factors in influencing the development of multiple sclerosis.