Multiple sclerosis. Primary health care implications

Multiple sclerosis is the most common neurologic disease disabling young adults less than 40 years of age in the United States. It is a chronic inflammatory disease of the central nervous system myelin, often viewed as an autoimmune disorder. Due to the difficulty in establishing a diagnosis, several years may pass between first onset of symptoms and an accurate diagnosis. The etiology remains unclear, but current research leans toward an immunologic and viral pathogenesis. The three main goals of treatment are to delay progression of disease, manage chronic symptoms, and treat acute exacerbations. While no cure has been found, copolymer 1 and interferon beta are each generating excitement in possibly delaying progression of multiple sclerosis. As the disease causes a set of highly variable and complex consequences, patients often require care from a multidisciplinary team of health care providers. Therefore, it is essential that primary care providers possess a basic understanding of the etiology, clinical features, prognosis, and treatment of multiple sclerosis.