This issue of Continuum is devoted to the diagnosis and management of our patients with multiple sclerosis (MS) and other central nervous system (CNS) demyelinating and inflammatory disorders, including neuromyelitis optica spectrum disorders (NMOSDs) and the evolving clinical entity of myelin oligodendrocyte glycoprotein (MOG)–antibody-mediated demyelinating syndromes. My sincere thanks go to Dr Dean M. Wingerchuk for enthusiastically accepting my invitation to be guest editor of this issue and for enlisting a team of experts in the field to help keep us informed of the state of the art of the diagnosis and care of our patients with these disorders.
My sincerest thanks go to Dr Dean M. Wingerchuk for enthusiastically accepting my invitation to be guest editor of this issue and for enlisting a team of experts in the field to help keep us all informed of the state of the art of the diagnosis and care of our patients with these disorders.
The issue begins with the article by Drs Bardia Nourbakhsh and Ellen M. Mowry, who inform us about the current thinking on the pathogenesis and risk factors for MS. Next, Dr Andrew J. Solomon provides us with an up-to-date review of the diagnosis and differential diagnosis of MS not only to inform our most accurate diagnosis of patients with the disease but to decrease the likelihood of misdiagnosis of MS in patients without the disorder. Dr Orhun H. Kantarci next provides his analysis of the phases and phenotypes of MS to inform our conception of the disease and its courses.
The next articles in this issue relate primarily to the management of patients with MS. First, Dr Pavle Repovic provides a detailed review of the current management of MS relapses. Dr Luanne M. Metz next describes the management of patients with clinically isolated syndrome and early relapsing MS. Dr James D. Bowen then reviews the management of patients with highly aggressive MS. Drs Robert H. Gross and John R. Corboy discuss the many issues we need to be aware of with regard to monitoring, switching, and stopping MS disease-modifying therapies. Dr Daniel Ontaneda then discusses clinical features and current therapeutic options for our patients with progressive MS. Finally, Dr W. Oliver Tobin discusses the symptomatic management of MS as well as its comorbidities.
Dr Annette M. Langer-Gould reviews the many issues that arise regarding pregnancy and family planning in MS, a complicated topic especially given the varied current therapeutic options with differing risks. Dr Tanuja Chitnis next provides a detailed review of the issues involved in diagnosis and management of the diverse spectrum of disorders that can be seen in pediatric patients that parallel the (MS and non-MS) demyelinating and inflammatory disorders seen in adults. In the final review article of the issue, Dr Eoin P. Flanagan provides an up-to-date summary of the evolving story of the non-MS CNS inflammatory and demyelinating diseases, including NMOSD, MOG-IgG disease, and many others.
In this issue’s Practice article, Dr Alexander D. Rae-Grant provides a case discussion to describe how to incorporate clinical practice guidelines and quality measures into high-quality cost-effective care for patients with MS.
After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs D. Joanne Lynn and Allison L. Weathers, you may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment and CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.
With this issue, I also would like to congratulate Dr Joseph Safdieh, who has graciously accepted my invitation to take on the overall Associate Editor duties for Continuum; he will be performing this important role in addition to his ongoing role as Associate Editor of Self-Assessment and CME, in which he oversees the SA-CME activities for Continuum.
I would like to thank Dr Wingerchuk for his expert guest editorship of this multifaceted and remarkable issue from its inception, his collaboration in choices of article concepts and titles, his enlisting of expert authors, his patience and thoughtfulness in the many revisions of the title of the issue itself, his skillful review of the detailed content, and his exceptional responsiveness throughout the process. The information presented in this issue should be of great benefit to each of us as we diagnose and manage (and avoid misdiagnosis of) the many patients who present to us with any disorders within the evolving and awe-inspiring spectrum of demyelinating and inflammatory disorders of the CNS.
- My sincere thanks go to Dr Dean M. Wingerchuk for enthusiastically accepting my invitation to be guest editor of this issue and for enlisting a team of experts in the field to help keep us all informed of the state of the art of the diagnosis and care of our patients with these disorders.
—STEVEN L. LEWIS, MD, FAAN