How to treat

Treatment paradigms in multiple sclerosis: who, when and how to treat? Willis MD, Robertson NP. J Neurol. 2014 Jun. [Epub ahead of print]

With an increasing array of disease-modifying therapies (DMTs) for multiple sclerosis (MS) now available, clinicians are faced with a range of difficult treatment decisions relating to patient selection, timing of interventions and response to treatment failure. A number of different treatment paradigms have been suggested including stepwise treatment escalation, personalised disease management and an induction/consolidation approach, but as yet there remains no consensus as to the most efficacious and least deleterious overall route for this patient population.

Neuros have this debate all the time, Do something; Do nothing, offer the risk, be risk averse, offer something new, be a treatment ludite an god forbid……be innovative…..Is the way that NICE issues guidance on who can have what and when the answer, so as neuros don’t have to think. Wonder how many neuros offer the choice above (no names please). 

No doubt by reading blogs like this you are being proactive and are trying to understand the choices available, but there are many people that we are not reaching. They shy away from the reality and the knowledge. They rely on their neuros to make/offer the right choices.

What is the best way to engage with more people? 

From some of the feedback I have heard it seemed that at the recent MS research day, organised by UCL, that the audience was populated by many MSer experts, who want more than a simple drugs pitch that they already know. Many want to know about stem cells, INSPIRE etc.

It seems that we may need a different format or formats.

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  • I was quite surprised at the conference on speaking to a couple of MSers who had never heard of this blog, and had got info on the conference from other sources. It must be difficult to know how to pitch a talk eg the one on what's available and coming up for drug treatment, as Dr. Miller(?) spent some time explaining interferons and GAs use and effects, which to a lot of us is well known, but perhaps some people out there didn't realise their mild efficacy compared to newer drugs.

  • How to better inform people about MS? Now you really are touching on social sciences. There are people who devote their academic careers to health communication and adapting marketing techniques to changing health attitudes and behaviors (social marketing).

    That said, I think you're doing a lot already. And I have seen your perspective starting to get passed along on the MS forums among MSers. It takes a bit of time, but I think you're getting through.

    It would be very helpful to have a collection of some of your best posts translated for newcomers…most people don't know what NEDA means, nor that its reasonable to expect that with treatment. They don't know the generic name of their meds, let alone what GA or alem is. With a few easy-to-read posts, I could send people on forums or among my MS friends more about where my ideas about things are coming from, instead of sounding like a crazy person all the time.

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