Multiple sclerosis: Newer concepts on pathophysiology, diagnostic criteria and therapeutics

Multiple sclerosis (MS) is a challenging and disabling demyelinating disorder, presumed to be of autoimmune origin. Various environmental and genetic risk factors have now been implicated in the etiopathogenesis of this disorder. Early and precise diagnosis is critical and is supported by use of recent revision of diagnostic criteria, incorporating imaging and spinal fluid abnormalities. Notably, the treatment armamentarium for MS has expanded substantially over the last two decades with approval of newer drugs and many other drugs in terminal stages of development. However, some of these therapies are associated with long-term effects on immune system and/or severe adverse events which can complicate ensuing therapies. The customisation of treatment requires consideration of many factors like safety, efficacy, patient related factors and finally a comprehensive risk-benefit assessment for an individual patient. This article is intended to help make informed ecisions, keep realistic goals and raising cognizance of multiple factors involved in treating patients with MS.