Management of Multiple Sclerosis Symptoms and Comorbidities

W. Oliver Tobin, MBBCh, BAO, PhD Multiple Sclerosis and Other CNS Inflammatory Diseases p. 753-772 June 2019, Vol.25, No.3 doi: 10.1212/CON.0000000000000732
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PURPOSE OF REVIEW: This article discusses the prevalence, identification, and management of multiple sclerosis (MS)–related symptoms and associated comorbidities, including complications that can present at all stages of the disease course.

RECENT FINDINGS: The impact of comorbidities on the outcome of MS is increasingly recognized. This presents an opportunity to impact the course and outcome of MS by identifying and treating associated comorbidities that may be more amenable to treatment than the underlying inflammatory and neurodegenerative disease. The identification of MS-related symptoms and comorbidities is facilitated by brief screening tools, ideally completed by the patient and automatically entered into the patient record, with therapeutic suggestions for the provider. The development of free, open-source screening tools that can be integrated with electronic health records provides opportunities to identify and treat MS-related symptoms and comorbidities at an early stage.

SUMMARY: Identification and management of MS-related symptoms and comorbidities can lead to improved outcomes, improved quality of life, and reduced disease activity. The use of brief patient-reported screening tools at or before the point of care can facilitate identification of symptoms and comorbidities that may be amenable to intervention.

Address correspondence to Dr W. Oliver Tobin, Mayo Clinic, Department of Neurology, 200 First St SW, Rochester, MN 55905, tobin.oliver@mayo.edu.

RELATIONSHIP DISCLOSURE: Dr Tobin receives research/grant support from Mallinckrodt Pharmaceuticals.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Tobin discusses the unlabeled/investigational use of amantadine, armodafinil, and modafinil for fatigue; lacosamide, lamotrigine, and oxcarbazepine for paroxysmal symptoms; gabapentin for restless legs syndrome and spasticity; and nabiximols, oral cannabis extract, and synthetic tetrahydrocannabinol for the treatment of spasticity.

© 2019 American Academy of Neurology.