Abstract

TORO, Jaime; REYES, Saúl  and  ZAMORA, Adrián. Controversies in Neurology: Multiple Sclerosis. Acta Neurol Colomb. [online]. 2014, vol.30, n.1, pp.32-48. ISSN 0120-8748.

Multiple sclerosis (MS) is the most common demyelinating disorder of the central nervous system, and contributes greatly to health care costs and disability in young adults. Despite advances in diagnostic techniques and treatment, several important issues remain controversial. We addressed fifteen specific controversies that arise at the bedside and affect clinical practice, education and research in MS. We reviewed these issues followed by some opinions as to how use the best available evidence in a way that support clinical decisions. Topics discussed include utility of oligoclonal IgG bands in the diagnosis and prognosis of multiple sclerosis, cost-effectiveness of disease-modifying therapies, change from first- to second-line treatment, indications for follow-up MR imaging, plasma exchange, radiologically isolated syndrome, discontinuation of immunomodulatory therapies, home administration of intravenous methylprednisolone, duration of corticosteroids treatment, role of optical coherence tomography, vitamin D deficiency and supplementation, management of secondary progressive multiple sclerosis, emerging therapies and interferon during pregnancy. A systematic review of the literature was conducted using MEDLINE, Embase, Cochrane and the Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) databases. Answers to the targeted questions were formulated and specific recommendations were made with the hope to stimulate future research.

Keywords : Multiple sclerosis; Multiple sclerosis chronic progresive; oligoclonal bands; Interferons; magnetic resonance Imaging.

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