Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis--performance improvement CME.

Background: Symptom management remains a challenging clinical aspect of MS.

Objective: To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity.

Methods: Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment.

A case of natalizumab-associated progressive multifocal leukoencephalopathy with repeated negative CSF JCV testing.

The development of progressive multifocal leukoencephalopathy (PML) in patients treated with natalizumab is a well-known potential risk. Diagnosis of PML can be confounded in patients with multiple sclerosis (MS) if new demyelinating lesions develop, and the sensitivity of existing diagnostic tests is less than ideal. In the case presented here, four samples of cerebrospinal fluid tested negative for John Cunningham virus (JCV) DNA by polymerase chain reaction, yet brain biopsy eventually proved positive by immunohistochemistry.

Alphabet soup: a personal, evolving, mostly evidence-based and logical, sequential approach to the "ABCNR" drugs in multiple sclerosis.

With the development of multiple options for immunotherapy in multiple sclerosis, the clinician is faced with the challenge of keeping pace with the literature, acquiring familiarity with the various treatment options and opinions, and then offering the patients the most current and appropriate management. Given the inherent nature of a multifocal and unpredictable disease such as multiple sclerosis, along with the availability of multiple treatment options, it behooves the clinician to develop an evidence-based rationale for how to best manage patients. This article reflects the common questions that arise from referring neurologists regarding my personal approach to the management of patients with multiple sclerosis.

Update on the diagnosis of multiple sclerosis.

The diagnosis of multiple sclerosis has been increasingly standardized over the years and has evolved to incorporate new diagnostic modalities. The gold standard for diagnosing multiple sclerosis remains clinical, with dissemination of typical white matter symptoms and signs in time and space. The Schumacher criteria in 1965 attempted to standardize clinical criteria for diagnosing multiple sclerosis.