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The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

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Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command.

Mark S Freedman¹, Bruce Cohen, Suhayl Dhib-Jalbut

¹University of Ottawa, Smyth Rd., Ottawa, ON, Canada K1H 8L6. mfreedman@ottawahospital.on.ca

Current Medical Research and Opinion

|August 15, 2009

Summary

Managing multiple sclerosis (MS) that is suboptimally controlled remains challenging due to a lack of evidence-based treatment guidelines. Individualized approaches are needed to optimize therapies for patients with breakthrough disease activity.

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Area of Science:

Neurology
Immunology

Background:

Current multiple sclerosis (MS) therapies offer disease reduction but not complete control.
Suboptimally controlled MS presents significant challenges in clinical management.

Purpose of the Study:

To review definitions and treatments for suboptimally controlled MS.
To increase clinician awareness in recognizing and managing these patients.

Main Methods:

Literature search of EMBASE and MEDLINE for treatment failure and optimization studies.
Inclusion of expert panel discussions on diagnosing and treating suboptimally controlled MS.

Main Results:

Recommendations exist for evaluating suboptimal response to disease-modifying drugs (DMDs).
Limited evidence-based data guide treatment decisions for suboptimal response.
Proposed treatment paradigms include step therapy and platform therapy approaches.

Conclusions:

Identifying and treating MS with suboptimal response to platform therapies is challenging without robust data.
Developing algorithms to quantify breakthrough disease activity is a key goal.
Individualized step therapy and consideration of all factors influencing DMD efficacy are crucial.