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Abstract
Multiple sclerosis continues to be a challenging and disabling condition but there
is now greater understanding of the underlying genetic and environmental factors that
drive the condition, including low vitamin D levels, cigarette smoking, and obesity.
Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating
imaging and spinal fluid abnormalities for those presenting with a clinically isolated
syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral
and by infusion, for those with the relapsing remitting form of the disease. Careful
consideration is required when choosing the correct treatment, balancing the side-effect
profile with efficacy and escalating as clinically appropriate. This move towards
more personalised medicine is supported by a clinical guideline published in 2018.
Finally, a comprehensive management programme is strongly recommended for all patients
with multiple sclerosis, enhancing health-related quality of life through advocating
wellness, addressing aggravating factors, and managing comorbidities. The greatest
remaining challenge for multiple sclerosis is the development of treatments incorporating
neuroprotection and remyelination to treat and ultimately prevent the disabling, progressive
forms of the condition.