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Patient Care Process for Multiple Sclerosis



  • Patient specific demographics such as age, race, gender, geographical places of residence before or after the age of 15, current smoking level and history, family history of MS, and previous infection with certain viruses.

  • Laboratory values such as vitamin D, liver function tests, complete metabolic panel, and complete blood count

  • Magnetic Resonance Imaging (MRI) of brain and spinal cord with and without contrast

  • Lumbar puncture for oligoclonal bands

  • Visual evoked potential results

  • Optical coherence tomography (OCT)

  • Current diagnosis and date of initial diagnosis and current and past medications.


  • Clinical classification of MS (RRMS, SPMS, PPMS, or PRMS)

  • Progression of diseases using the Expanded Disability Status Scale (EDSS), and MRI

  • Total number of disease exacerbations or relapses

  • Duration of therapy and dose for current and past medications, side effects experienced during treatment, and medication adherence.


  • Choose a therapy that has the best risk vs. benefit profile for use in the specific form of MS diagnosed, as well as patient specific characterizations and previous treatment history.

  • Choose a therapy with the best adherence profile (twice yearly infusion vs. 3 times weekly injectable), and more tolerable side effects based on stratified risk factors (JC virus).

  • Create a patient specific monitoring plan based on the therapy chosen

  • Identify presence of secondary symptoms requiring pharmacologic management


  • Start primary MS therapy as soon as possible to decrease the chance for disease progression during treatment changes.

  • Add pharmacologic treatment for secondary symptoms when appropriate

  • Discuss with patients the role of complementary and alternative treatments

Follow up: Monitor and Evaluate

  • Safety of current DMT at each visit to ensure the current treatment is best fitted for the specific patient case.

  • Monitor for common side effects with each specific DMT, or any side effects that are new once therapy is initiated or changed.

  • Treatment response (reduction in primary, secondary and tertiary symptoms of MS) or the occurrence of exacerbations and relapses.

  • Change in lesions via yearly MRI.

  • Change in daily functioning using the Expanded Disability Status Scale (EDSS) and other clinical factors used to predict MS prognosis.


Content Update

July 3, 2019

New Disease Modifying Therapies (DMTs) for Relapsing Forms and Active Secondary Progressive Multiple Sclerosis: In March 2019, two disease modifying therapies (DMTs) were approved by the U.S Food and Drug Administration (FDA) for treatment of certain types of multiple sclerosis (MS). Siponimod (Mayzent®) is a sphingosine 1-phosphate (S1P) receptor modulator that showed a reduction in annualized relapse rates and disability progression with a side effect profile similar to the other available S1P receptor modulator, fingolimod. Cladribine (Mavenclad®) depletes lymphocytes and also showed efficacy by reducing annualized relapse rates and lesions on MRI; however, the side effects of cladribine can be serious and limit its use to patients with more active disease.

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