Multiple Sclerosis: Approaches to Early Diagnosis and New Treatment Options

ultiple sclerosis (MS) is an idiopathic inflammatory disease of the central nervous system that is characterized by demyelination and subsequent axonal degeneration. It is the most common nontraumatic cause of disability in young adults, generally striking between the ages of 15 and 50 years. Estimates place the prevalence at 250 000 to 350 000 people in the United States alone, but the true prevalence is believed to be higher as MS can remain undiagnosed for years, even decades. A recent estimate put the annual cost of MS in the United States at $6.8 to $11.9 billion including the cost of lost productivity, pointing to the harsh economic impact of this disease and the need for treatment. Women are twice as likely as men to develop MS, and epidemiologic data also point to people of Northern European ancestry as being particularly vulnerable. However, the ethnic profile of the MS population seen, for instance, in Baltimore shows a much broader-based ethnicity; 11% of our patients are African American. Because the symptoms of MS spontaneously remit, the disease frequently goes undiagnosed for many years. An alert primary care clinician can make a crucial difference by recognizing the symptoms of MS and facilitating prompt diagnosis and treatment.