Multiple Sclerosis Medical Slides

Present both strategies with evidence: traditional escalation starts with moderate-efficacy drugs (interferons, glatiramer, dimethyl fumarate) and escalates after breakthrough activity. The emerging treat-to-target approach starts with high-efficacy therapies (natalizumab, ocrelizumab, alemtuzumab) early, supported by retrospective data showing less disability accumulation. Reference the TREAT-MS and DELIVER-MS trials comparing these approaches prospectively.

Show characteristic lesion locations meeting DIS criteria: ≥1 T2 lesion in at least 2 of 4 regions (periventricular, cortical/juxtacortical, infratentorial, spinal cord). Demonstrate DIT with simultaneous gadolinium-enhancing and non-enhancing lesions or new T2 lesions on follow-up. Teach the "central vein sign" on 3T MRI as an emerging biomarker differentiating MS from microvascular disease.

Define a true relapse as new or worsening neurological symptoms lasting >24 hours in the absence of fever or infection (Uhthoff phenomenon). Pseudo-relapses are reactivation of prior symptoms triggered by infection, heat, stress, or fatigue. Teach the workup: urinalysis, CBC, and temperature check before treating with IV methylprednisolone 1g daily for 3-5 days. PLEX is reserved for steroid-refractory severe relapses affecting ambulation or vision.