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Multiple Sclerosis


Multiple sclerosis (MS, disseminated sclerosis, encephalomyelitis disseminata) is an inflammatory demyelinating disease of the central nervous system. Multiple sclerosis is divided into the following categories: Relapsing-remitting MS, Secondary progressive MS, Primary progressive MS and Progressive-relapsing MS.


Individuals with multiple sclerosis can present almost any form of neurological symptom [7]. The most common problems are sensory, autonomic, visual and motor. The specific symptoms are determined by where the lesions are located within the nervous system. General presentations include the following:

  • We allowed concurrent spasm related pain if the patient was able to distinguish spasm related pain and central pain. We allowed additional pain outside the maximal pain site if pain intensity was low and distinguishable from the central pain.[bmj.com]
  • The reader will be provided with current, evidence-based knowledge about the treatment of MS-related pain, and the review will take a practical approach to the various drugs for treating pain, including starting dose, titration and side effects.[informahealthcare.com]
  • Conclusions: Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated.[neurology.org]
  • As for pain, painful conditions are handled with drugs such as anticonvulsants, nonsteroidal anti-inflammatory agents, and corticosteroids. Nevertheless, management of pain in MS remains controversial and underresearched.[doi.org]
  • Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B).[n.neurology.org]
  • Fatigue was measured by questionnaires (i.e. Checklist Individual Strength, Modified Fatigue Impact Scale), and the dimensions subjective, physical, cognitive and psychological fatigue were distinguished.[ncbi.nlm.nih.gov]
  • Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS) and provides an indication of fatigue experienced by an individual in three domains; physical, cognitive, and psychosocial.[dx.doi.org]
  • After improvement in motor weakness, we found that the lower amplitude of the readiness field and decreased ECD strength of the MEF observed in affected hemisphere during motor weakness had recovered.[ncbi.nlm.nih.gov]
  • A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control.[icd9data.com]
  • Early MS symptoms include weakness, tingling, numbness, and blurred vision. Other signs are muscle stiffness, thinking problems, and urinary problems. Treatment can relieve MS symptoms and delay disease progression.[web.archive.org]
  • […] pathophysiology believed to be caused by a combination of genetic, environmental and infectious factors recent research suggests a T-cell mediated autoimmune mechanism Associated conditions orthopaedic increased fracture risk relating to increased risk of falling[orthobullets.com]
  • BRAVO results were presented last fall at the 5th Joint Triennial Congress of the European and American Committees for Treatment and Research in Multiple Sclerosis (ECTRIMS/ACTRIMS) in Amsterdam, The Netherlands.[medscape.com]
  • In that case, however, people with M.S. should also have a high incidence of broken bones because of their falls.[nytimes.com]
  • These sensations are similar to the pins-and-needles feeling you get when your foot falls asleep. However, they occur for no apparent reason. Uneven balance and weak legs.[healthline.com]
Difficulty Walking
  • Difficulty walking Difficulty walking can occur with MS for a number of reasons: numbness in your legs or feet difficulty balancing muscle weakness muscle spasticity difficulty with vision overwhelming fatigue Difficulty walking can also lead to injuries[healthline.com]
  • Symptoms, like fatigue, difficulty walking, vision problems and cognitive changes, can be severe and disabling, and can take a heavy toll on patients.[cbsnews.com]
  • However, common symptoms of MS include changes in sensation or sensory symptoms such as tingling and numbness, and changes in muscle function or motor symptoms such as difficulty walking, stiffness or tremors.[ucsfhealth.org]
  • That leads to problems like: vision problems fatigue or weakness difficulty walking or trouble with balance or coordination numbness or the pins-and-needles tingling you feel when your foot falls asleep memory problems MS is mostly a disease that adults[kidshealth.org]
  • The main symptoms include: fatigue difficulty walking vision problems, such as blurred vision problems controlling the bladder numbness or tingling in different parts of the body muscle stiffness and spasms problems with balance and co-ordination problems[nhs.uk]
Fecal Incontinence
  • incontinence may occur occasionally in some patients Depression is common and unrelated to cognitive impairment although it may worsen existing cognitive difficulties Approx 10% of patients with Multiple Sclerosis will suffer severe psychotic disorders[themcfox.com]
  • Jillian Marie McDowell, Susan Heather Kohut and Gillian Margaret Johnson, Trigger Point Acupuncture (Dry Needling) and Associated Fecal Incontinence in Multiple Sclerosis: A Case Report, Medical Acupuncture, 27, 4, (283), (2015).[oadoi.org]
  • incontinence,increased gut permeability and increased occurrence of inflammatory bowel diseases in MS patients and their families,suggest an important gut–CNS connection.[physio-pedia.com]
Muscle Spasm
  • He obtained immediate benefit from a small dose of the drug, reporting decreased pain from muscle spasm, cessation of nocturia, and an improvement in how he felt generally.[medicalcannabis.it]
  • Muscle symptoms: Loss of balance Muscle spasms Numbness or abnormal sensation in any area Problems moving arms or legs Problems walking Problems with coordination and making small movements Tremor in one or more arms or legs Weakness in one or more arms[nlm.nih.gov]
  • Muscle spasms, musculoskeletal stiffness and pain—the main outcomes of this trial—were reported as AEs at low frequencies, and with only small differences between treatment groups.[jnnp.bmj.com]
Restless Legs Syndrome
  • Secondary objectives were to investigate correlations of sleep quality and daytime sleepiness (ESS), depression (HADS-D), anxiety (HADS-A), pain (HSAL), and restless legs syndrome (RLS).[ncbi.nlm.nih.gov]
  • The patient presented with progressive decrease of visual acuity, intermittent diplopia, paresthesia of the left arm and equilibrium disturbances.[ncbi.nlm.nih.gov]
  • […] episodes of neurological dysfunction (brain, spinal cord or optic nerves) that are separated in time and space Symptoms symptoms of disease are based on the systems involved psych fatigue, depression, mood disorders central nervous system optic neuritis, diplopia[orthobullets.com]
  • Eye problems : In addition to the optic neuritis that comes with CIS, MS can cause: Nystagmus : involuntary eye movements Diplopia: double vision Fatigue : You may feel very tired.[webmd.com]
  • […] sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia[disabled-world.com]
  • Examples of common clinical features include 23,24 : brainstem and cranial nerve involvement: optic neuritis internuclear ophthalmoplegia (often bilateral) trigeminal neuralgia diplopia (e.g. due to abducens nerve palsy ) vertigo cerebellum involvement[radiopaedia.org]
Blurred Vision
  • Early MS symptoms include weakness, tingling, numbness, and blurred vision. Other signs are muscle stiffness, thinking problems, and urinary problems. Treatment can relieve MS symptoms and delay disease progression.[web.archive.org]
  • Female aged 16, with Relapsing Remitting Multiple sclerosis (RRMS) was reported with initial symptoms of blurred vision, severe immobility, upper and lower limb numbness and backache.[ncbi.nlm.nih.gov]
  • Symptoms Some examples of the symptoms seen in MS include: Vision problems such as blurred vision, double vision or paralysis of eye muscles Muscle stiffness and lack of balance and co-ordination. There is loss of dexterity and fine movement.[news-medical.net]
  • Common symptoms of a relapse may include: Fatigue Numbness Tingling Blurred vision, double vision or loss of vision Unsteady gait Weakness These symptoms tend to persist for days or weeks, and then disappear partially or completely on their own or with[hopkinsmedicine.org]
  • Case 2 A 27-year-old man came to our observation complaining from one week of blurred vision in the left eye with pain during ocular movements. No significant medical event had occurred previously.[dx.doi.org]
Eye Pain
  • A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left.[ncbi.nlm.nih.gov]
  • Early MS symptoms may include: weakness/fatigue loss of balance problems with coordination tremors tingling and/or numbness blurred or loss of vision muscle stiffness/cramping thinking problems depression bowels problems facial or eye pain It is still[drfuhrman.com]
  • You may also have some eye pain. It isn’t uncommon for these early symptoms to go away only to return later. You may go weeks, months, or even years between flare-ups. These symptoms can have many different causes.[healthline.com]
  • Early signs According to the National Institute of Neurological Disorders and Stroke (NINDS), the early signs of MS include : blurred or double vision optic neuritis, leading to eye pain and rapid vision loss weakness and stiffness in the muscles painful[medicalnewstoday.com]
  • Common symptoms include: Vision problems, including double vision, blurriness, partial color blindness, eye pain, and partial or complete loss of vision Thinking and memory problems Fatigue Muscle weakness Dizziness Numbness or weakness on one side or[familydoctor.org]
  • Ninety percent of MS patients showed central scotoma every time, but 54% in NMO (p 0.022). In NMO patients, 33% of patients showed both central scotoma and non-central scotoma, and 13% of patients showed non-central scotoma every time.[dx.doi.org]
  • Visual: 0 ‐ Normal, 1 ‐ Scotoma with corrected acuity 20/30, 2 ‐ Scotoma with worse eye corrected acuity 20/30 to 20/59 ..... 6 ‐ Worse eye corrected acuity 20/200 and betetr eye 3.0 ‐ Moderate disability in 1 FS, or mild disability in 3‐4 FS.[doi.org]
  • […] selected based on the history and physical examination findings and may include any of the following: Complete blood count (CBC) to evaluate for features of anemia, leukemia, or leukocytosis Serum vitamin B-12 and folate levels (eg, bilateral central scotoma[emedicine.com]
  • MRI-detected spinal cord lesions longer than 3 spinal segments and primarily involving the central part of the spinal cord on axial sections; (2) optic neuritis is bilateral and severe or associated with a swollen optic nerve or chiasm lesion or an altitudinal scotoma[ncbi.nlm.nih.gov]
Central Scotoma
  • Ninety percent of MS patients showed central scotoma every time, but 54% in NMO (p 0.022). In NMO patients, 33% of patients showed both central scotoma and non-central scotoma, and 13% of patients showed non-central scotoma every time.[dx.doi.org]
  • scotoma) Lyme titers (eg, endemic area, tick exposure, rash of erythema chronica migrans) Tuberculin skin testing, chest radiography, or QuantiFERON-TB testing (eg, tuberculosis [TB] exposure, endemic area) Fluorescent treponemal antibody (FTA) testing[emedicine.com]
Facial Pain
  • pain Painful muscle spasms Tingling, crawling, or burning feeling in the arms and legs Other brain and nerve symptoms: Decreased attention span, poor judgment, and memory loss Difficulty reasoning and solving problems Depression or feelings of sadness[nlm.nih.gov]
  • Symptoms and signs of MS are extremely variable and range from mild to severe, and may include: Problems with balance when walking Hearing loss Facial pain Weakness Muscle spasms that cause pain.[emedicinehealth.com]
  • Pain is a common symptom present in MS and can present acutely or as chronic pain [1] . o Acute Pain Treatment - Trigeminal neuralgia—stab-like facial pain with anticonvulsants • Carbamazepine (Tegretol) or phenytoin (Dilantin) [1] [2] - Lhermitte’s sign—stabbing[physio-pedia.com]
Emotional Lability
  • Vertigo, incoordination and other cerebellar problems, depression, emotional lability, abnormalities in gait, dysarthria, fatigue and pain are also commonly seen.[library.med.utah.edu]
  • […] enemas when habit changes and oral measures are not enough to control the problems.[85][88] Cognitive and emotional: neuropsychiatric symptomatology is common in the course of the disease.[89] Depression and anxiety appear in up to 80% of patients,.[90] Emotional[en.wikipedia.org]
Decreased Libido
  • RESULTS: Approximately 70% of the patients complained at least 1 SD (decreased libido, erectile dysfunction, premature or retarded ejaculation, painful penetration), and 22% of them reported the disorder as frequent.[ncbi.nlm.nih.gov]
  • Sexual Symptoms: impotence, decreased libido, decreased ability to achieve orgasm.[physio-pedia.com]
Psychiatric Manifestation
  • Psychiatric manifestations of multiple sclerosis: A review. Can J Psychiatry 1996 ; 41: 441 – 445. Google Scholar SAGE Journals ISI 5. Patten, SB, Svenson, LW, Metz, LM. Psychotic disorders in MS: Population-based evidence of an association.[dx.doi.org]
  • She has a mild fever, confusion, speech and coordination disorders, dizziness, worsening of memory, inability to walk (inferior paraparesis). Focal lesions were detected on MRI scan. The spinal fluid contained oligoclonal IgG-chains and HHV-7 DNA.[ncbi.nlm.nih.gov]
  • CBM was generally well tolerated, although more patients on CBM than placebo reported dizziness, dry mouth, and somnolence. Cognitive side effects were limited to long-term memory storage.[neurology.org]
  • These reactions include, but are not limited to, itchy skin, rash, hives, skin redness, flushing, low blood pressure, fever, tiredness, dizziness, headache, throat irritation, shortness of breath, swelling of the throat, nausea, and fast heartbeat.[web.archive.org]
  • Gait and mobility changes : MS can change the way people walk, because of muscle weakness and problems with balance, dizziness, and fatigue.[medicalnewstoday.com]
  • We narrate the case of a 28-year gentleman known to have severe mitral stenosis, who presented with history of multiple stroke-like episodes. During each episode, he had CT brain done and was labelled as having recurrent embolic strokes.[ncbi.nlm.nih.gov]
  • Reich at the National Institute of Neurological Disorders and Stroke, 10 Center Dr., MSC 1400, Bldg. 10, Rm. 5C103, Bethesda, MD 20892, or at [email protected]. Article Figures/Media[nejm.org]
  • Abstract Based on one patient's enthusiastic report, eight patients with multiple sclerosis, seriously disabled with tremor and ataxia, were given oral tetrahydrocannabinol. Two demonstrated improved motor coordination.[ncbi.nlm.nih.gov]
  • Tetrahydrocannabinol for tremor in multiple sclerosis . Ann Neurol 1983 ; 13: 669 - 671 . Google Scholar Medline ISI Robson P. Cannabis as a medicine: time for the phoenix to rise? BMJ 1998 ; 316: 1034 - 1035 .[msj.sagepub.com]
  • ‘Medusa head ataxia’: The expanding spectrum of Purkinje cell antibodies in autoimmune cerebellar ataxia. Part 3: Anti-Yo/CDR2, anti-Nb/AP3B2, PCA-2, anti-Tr/DNER, other antibodies, diagnostic pitfalls, summary and outlook.[journals.sagepub.com]
  • Abstract Based on one patient's enthusiastic report, eight patients with multiple sclerosis, seriously disabled with tremor and ataxia, were given oral tetrahydrocannabinol. Two demonstrated improved motor coordination.[ncbi.nlm.nih.gov]
  • Key Words: Multi ple sclerosis—Ataxia—Physical therapy. Schneitzer L. Rehabilitation of patients with multiple sclerosis Arch Phys Med Rehabil 1978 ,59. 430 - 7.[dx.doi.org]
  • In this review we describe conditions that may be confused with MS because they can present as lesions disseminated in time, space, or both.[ncbi.nlm.nih.gov]
  • Other multifocal illnesses or white-matter diseases are seldom confused with multiple sclerosis.[oadoi.org]
Sexual Dysfunction
  • However, it could not predict the extent of sexual dysfunction. Sildenafil is unlikely to help all patients with neurogenic female sexual dysfunction. References 1 : Sexual dysfunction in the United States: prevalence and predictors.[dx.doi.org]
  • From 97 to 30% of the subjects reported cannabis improved (in descending rank order): spasticity, chronic pain of extremities, acute paroxysmal phenomenon, tremor, emotional dysfunction, anorexia/weight loss, fatigue states, double vision, sexual dysfunction[ncbi.nlm.nih.gov]
Urinary Incontinence
  • If nerve fibers to the bladder are affected, urinary incontinence may occur. Likewise, damage to the cerebellum portion of the brain may result in imbalance or a lack of coordination.[ucsfhealth.org]
  • Urinary incontinence in neurological disease: Management of lower urinary tract dysfunction in neurological disease (CG148). London : NICE, 2012. Google Scholar 8. Uroweb. EAU guidelines on neuro-urology, (accessed 2 September 2015).[dx.doi.org]
  • As a result, most people with multiple sclerosis have problems controlling their bladder, such as the following: Frequent and strong urges to urinate Involuntary passage of urine (urinary incontinence) Difficulty starting to urinate Retained urine can[merckmanuals.com]
  • incontinence others: fatigue depression Uhthoff phenomenon: heat and exercise worsen symptoms cognitive decline Classification A number of patterns of longitudinal disease have been described 11,12 : relapsing-remitting most common (70% of cases) patients[radiopaedia.org]
Urinary Retention
  • retention A constant state of tiredness or fatigue There appears to be a relationship between multiple sclerosis, higher temperatures, and the worsening of symptoms.[emedicinehealth.com]
  • During 1828, he had unpleasant sensory symptoms and fatigue but continued with his military career until developing urinary retention; he became constipated, had a single episode of faecal incontinence and found himself to be impotent whilst attempting[dx.doi.org]
  • retention ) Muscle spasticity Incoordination of muscles Tremor Painful involuntary muscle contractions Slurred speech Fatigue There are four types of MS: Relapsing-remitting multiple sclerosis (RRMS), Secondary-progressive multiple sclerosis (SPMS),[medicinenet.com]


Many patients seek medical help following an initial attack of symptoms often referred to as a clinically isolated syndrome or CIS. Some people who have a CIS do not go on to develop full multiple sclerosis and it is difficult to predict which patient will develop it and which one wouldn’t [8].

Since there is no definitive test for it, diagnosing multiple sclerosis is often a challenge. This is because there are many conditions that present the same symptoms as MS. For a confirmed diagnosis of multiple sclerosis, the doctor must find the following:

  • Evidence of nerve damage in at least two different areas of the central nervous system (brain, spinal cord, and optic nerves)
  • Evidence that the damage occurred in episodes that happened at least one month apart
  • No evidence that the damage is caused by other conditions
Central Scotoma
  • Ninety percent of MS patients showed central scotoma every time, but 54% in NMO (p 0.022). In NMO patients, 33% of patients showed both central scotoma and non-central scotoma, and 13% of patients showed non-central scotoma every time.[dx.doi.org]
  • scotoma) Lyme titers (eg, endemic area, tick exposure, rash of erythema chronica migrans) Tuberculin skin testing, chest radiography, or QuantiFERON-TB testing (eg, tuberculosis [TB] exposure, endemic area) Fluorescent treponemal antibody (FTA) testing[emedicine.com]
  • There was significant benefit favoring dirucotide in HLA-DR2–positive and/or DR4-positive participants (relative rate of progression 0.23, n 20, P .01).[oadoi.org]
  • […] swollen subacute stage plaques become paler in color ("chalky") abundant macrophages chronic stage (inactive plaques/gliosis) little or no myelin breakdown gliosis with associated volume loss appear grey/translucent Associations a strong association with HLA-DR2[radiopaedia.org]
  • Redundancy in antigen-presenting function of the HLA-DR and -DQ molecules in the multiple sclerosis-associated HLA-DR2 haplotype.[ncbi.nlm.nih.gov]


Presently there is no cure for MS but symptoms of MS can often be eased with the right medications [9].

Treatments generally fall into four categories:

  • Medicines that aim to modify the disease process.
  • Steroid medication to treat relapses.
  • Other medicines to help ease symptoms.
  • Other therapies and general support to minimise disability.


Except on rare occasions when the disease is severe, multiple sclerosis isn’t fatal. Many people with multiple sclerosis go on live to the average life expectancy for their sex in their region of residence. Most of them die of natural causes that affect everyone else [6]. However, the symptoms of MS can negatively affect the quality of life. This is perhaps why the rate of suicide amongst patients with multiple sclerosis is higher than normal.

Most patients with multiple sclerosis do not become severely disabled. Generally, most people diagnosed of the condition remain ambulatory without need for a wheelchair 20 years from time of initial diagnosis. However, many may have to use some sort of walking aid.


As is the cases with most autoimmune conditions, the exact cause of MS is unknown. However, it is believed that a combination of environmental and genetic factors play different roles.

Although multiple sclerosis isn’t hereditary, it appears that genetic factors help in making certain individuals susceptible to the disease process that leads to this condition. The major histocompatibility complex (MHC) is where the most significant genetic link to MS occurs. The MHC is a cluster of genes found on the Chromosome 6 that are important for the functions of the immune system.

Also, multiple sclerosis is most common in specific geographical regions in the world especially areas that are most far off from the equator (northern Europe and northern American countries). With the cluster of Multiple Sclerosis in this region, researchers have continued to investigate the role played by toxins, infections, deficiency in certain vitamins like the Vitamin D may be playing a major role in triggering MS in individuals that are susceptible genetically [3].


The number of individuals with multiple sclerosis around the world has been put at 2.5million approximately meaning that 30 out of every 100,000 people develop the condition. However, the rates vary greatly in based on regions [4]. It has been estimated that 18,000 deaths are recorded each year as a result of this condition. In America, incidence is 8.3 per 1000,000, in Europe 80 per 100,000. In South East Asia incidence is 2.8 per 100,000 people while in Africa rates are less than 0.5 cases per 100,000.

Rates of multiple sclerosis may appear to be increasing but this can be put down to better diagnosis available across board today.

The disease is seen mostly in adults in their late twenties or early thirties and rarely in childhood or after 50 years of age. Primary progressive multiple sclerosis is mostly seen in people in their late 50s. Also, as is the case with most autoimmune disorders, the disease is more common in women and the trend has continued to increase. In rare cases where children are affected, more females than males are affected.

Sex distribution
Age distribution


The three major characteristics of MS are the formation of lesions or plaques in the central nervous system, destruction of the myelin sheath of neurons and inflammation [5]. These interact in a complex manner that is not yet understood till date to initiate the disintegration of the nerve tissue and in turn, bring about the signs and symptoms of the disease. Damage is believed to be caused at least in part by attack on the nervous system by the individual's immune system.


There is no way to prevent multiple sclerosis and its attacks.


Also known as disseminated sclerosis or encephalomyelitis disseminata, multiple sclerosis (MS) is an inflammatory disease that damages the insulating covers of the nerve cells in the brain and the spinal cord [1]. This damage disrupts the ability of parts of the nervous system to communicate with the body and this brings about a wide range of symptoms which may cause psychiatric, mental or physical problems for the affected individual.

Multiple sclerosis takes several forms with each new symptom building up over a period of time (progressive forms) or occurring in relapsing forms (isolated attacks). Between the various attacks, some of the symptoms of MS disappears but it is possible to see permanent neurological problems as the disease continues to progress [2].

Patient Information

Multiple sclerosis is a disease that turns your immune system against the protective sheath covering your nerves (known as the myelin sheath).

When this happens, the communication between your brain and other parts of your body is affected. At the end of the day the nerves affected may deteriorate. This process is not reversible yet. 

The signs and symptoms of this condition varies widely as it is dependent on the amount of damage done to the nerves and what particular nerves were affected. In severe cases, people with this condition lose their ability to walk independently and in some instances, the individual may not see development of any new symptoms. 

Currently, there is no cure for multiple sclerosis but with treatments, the patient can recover properly from attacks and the symptoms of the condition can be managed. The treatments can also help in modifying the course of the disease.



  1. Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol. Dec 2005;58(6):840-6. 
  2. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. Mar 1983;13(3):227-31. 
  3. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. Apr 1996;46(4):907-11.
  4. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. Jul 2001;50(1):121-7. 
  5. Sanford M, Lyseng-Williamson KA. Subcutaneous recombinant interferon-ß-1a (Rebif®): a review of its use in the treatment of relapsing multiple sclerosis. Drugs. Oct 1 2011;71(14):1865-91
  6. Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 419.
  7. Farinotti M, Simi S, Di Pietrantonj C, McDowell N, Brait L, Lupo D, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004192.
  8. Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH, et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet. 2007 Aug 4;370(9585):389-97.
  9. Kappos L, Radue EW, O'Connor P, Polman C, Hohlfeld R, Calabresi P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010 Feb 4;362(5):416-26. Epub 2010 Jan 20.
  10. Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007256002819.

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Last updated: 2019-07-11 21:28