Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines
B Yamout 1, M Sahraian 2, S Bohlega 3, M Al-Jumah 4, R Goueider 5, M Dahdaleh 6, J Inshasi 7, S Hashem 8, I Alsharoqi 9, S Khoury 10, M Alkhawajah 11, S Koussa 12, J Al Khaburi 11, A Almahdawi 13, T Alsaadi 14, E Slassi 15, S Daodi 16, M Zakaria 17, R Alroughani 18
Affiliations
Affiliations
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: yamoutba@gmail.com.
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
- King Fahad Medical Cit, MOH, Riyadh, Saudi Arabia.
- Service de Neurologie, Hôpital Razi, Manouba, Tunis.
- Al Khalidi Hospital, Amman, Jordan.
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates.
- Faculty of Medicine, Cairo University, Cairo, Egypt.
- Dept of Clinical Neurosciences, Salmaniya Medical Complex, Manama, Bahrain.
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon.
- Department of Neurology, The Royal Hospital, Sultanate of Oman.
- MS Center- Geitaoui Lebanese University Hospital, Beirut, Lebanon.
- Consultant neurologist, neurology unit, Baghdad Teaching Hospital, Medical City Complex, Iraq.
- American Center for Psychiatry & Neurology- UAE.
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca- Morocco.
- Hospital Center Nedir Mohamed, Faculty of Medicine University Mouloud Mammeri Tizi-ouzou Algeria.
- Ain Shams University, Cairo, Egypt.
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait.
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of multiple sclerosis (MS) therapies is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, and progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
Conflict of interest statement
Declaration of Competing Interest The authors received honoraria from Biologix (the distributor for Biogen Idec across the Middle East and North Africa region) for serving on their advisory board and from other pharmaceutical companies including Novartis, GSK, Bayer, Merck, Sanofi and Roche. The manuscript represents the views and opinions of the members involved in the development of the guidelines. There is no industrial or pharmaceutical support or bias in the selection of the members or the recommendations reached. This effort was sponsored and carried out under the supervision of MENACTRIMS (The Middle East and North Africa Committee for Treatment and Research In Multiple Sclerosis).
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