It wasn't too long ago that two words — multiple sclerosis —  evoked visions of unrelenting disability, loss of function, sadness and isolation. But at the end of the last century, a more positive perspective emerged, following the approval of disease-modifying medications and a philosophical shift in the medical and healthcare of all those affected by multiple sclerosis.  

In the 21st century, a new philosophy has emerged — one based on research and the benefits of prompt diagnosis, early treatment and a team approach to healthcare. Disease phenotypes have been tightened to portray the disease characteristics rather than a confusing spectrum of meaningless terms. Treatment is becoming more personalized based on individual characteristics and symptoms rather than based on a meaningless list or chart of descriptors.

A faster diagnosis

A new standard of care has emerged, one which emphasizes the urgency of a prompt diagnosis by expert clinicians enhanced by neuroimaging techniques that allow visualization of the brain and spinal cord. The McDonald criteria, developed within the past two decades, is updated regularly to facilitate the diagnosis of MS within days, rather weeks or months. The original diagnostic criteria required documentation of neurologic episodes separated in space and time in order for clinicians to confirm a diagnosis of MS. This resulted in delays of months or years before people with MS were diagnosed and treated. 
The McDonald criteria substitutes specified criteria based on neuroimaging to confirm the patient’s diagnosis and facilitate prompt and appropriate treatment. In less than 50 years, the mantra surrounding MS went from “diagnose and adios” to “treat and beat it” thanks to disease-modifying therapies.

Making it personal

This new philosophy recognizes of the importance of the patient’s voice — my disease, my symptoms and my responsibility — and expands with the concept of partnerships.  

Starting from the first symptoms, the patient is best served by seeking healthcare by knowledgeable and experienced professionals. Comprehensive care for the disease, along with symptomatic management, encompasses the newest philosophy of MS care. Based on an evidence-based understanding of MS, the role of the MS clinician has been transformed from a supportive, educative role to that of a highly skilled, knowledgeable and specialized professional who is part of a multi-disciplinary team dedicated to a patient’s continuing care. MS specialists impart knowledge medications, wellness activities, reduction of risks and side effects, and facilitate self-management to promote sustained adherence. Regular contact with patients, a consistent level of care, a trusting relationship and a greater understanding of prescribed treatment have resulted in a knowledgeable and competent population of patients and their families.

The history of MS has been a rich and dynamic tale but the story has not ended. We will continue to seek better treatments and better care with a goal of conquering this complex condition with a cure.  In the meantime, we shall continue to strive to improve the quality of life for all those affected by multiple sclerosis.