Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system that is characterized by inflammation, demyelination and degenerative changes. MS constitutes the most frequent cause of non-traumatic disability in the young adult population.

Most of the patients have a relapsing course from onset (relapsing remittent MS) that is characterized by relapses and remission of neurological symptoms associated with areas of CNS inflammation, and over the course of two decades more than half of untreated patients transition to a phase of gradual worsening independent of acute attacks (secondary progressive MS). Progressive forms of MS can be present as the initial disease course (primary progressive MS).

The current therapeutic strategy for MS is aimed at reducing the risk of relapses and potentially disability progression. Recently, the growing armamentarium of therapies brings new opportunities for individualized therapy where patients and providers must balance considerations around efficacy, side effects and potential harm in a shared decision process. However, the variety of mechanisms of action, monitoring requirements and risk profiles together with the existing knowledge gaps make individualized medicine a complex task. There is still controversy about the relative efficacy of the drugs available, who should receive therapy and the optimum time to start. The heterogeneity of MS makes it difficult to choose the appropriate drug. Moreover, despite the identification of several prognostic factors, there is no accepted consensus definition that allows physicians to classify patients into high risk and low risk groups in order to prioritize treatment strategies.

➡️Scope and Purpose

This guideline covers the management of MS and its subtypes. This edition includes updated evidence with literature searches completed up to September 2022 and with some major publications since that date also included. This guideline is not intended to overrule regulations or standards concerning the provision of services and should be considered in conjugation with them. In considering and implementing this guideline, users are advised to also consult and follow all appropriate legislation, standards and good practice.

The national guideline for MS clarifies the quality improvement opportunities in the management of MS and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goal is to improve the practice of neurologists as regards the management of relapses and use of Disease Modifying Therapies (DMTs) in the different types of MS.

➡️The target audience

The guideline is intended for all the medical specialists who are likely to diagnose and manage MS especially the neurologists, pharmacists and nurses, and it applies to any setting in which MS would be identified, monitored, or managed.