Multiple sclerosis: A comprehensive review for the osteopathic provider

Abstract

Multiple sclerosis (MS) is an uncommon neurological pathology frequently initially discovered by primary care providers in their workup of new focal neurological deficits. Many cases go undiagnosed for years despite multiple flares, with risk of cumulative disability. Early treatment is key to slowing or preventing the accumulation of this disability and maximizing function in the long term. This literature review covers all aspects of MS, including pathophysiology, diagnostic testing and differential diagnosis, disease classification, and disease-modifying agents for acute and chronic treatment. This study also summarizes support services, including osteopathic manipulative treatment, that help to maximize patient function and independence. While better therapeutics continue to emerge, significant limitations, side effects and continued progression—despite optimal therapy—result in progressive and irreversible loss of function for many patients. Heightened awareness of current progress in MS diagnosis criteria and initial testing amongst primary care providers can shorten the time to treatment and formal diagnosis, allowing patients to live their best lives despite their MS diagnosis.