Talk:Multiple sclerosis/Archive 4

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Tysabri

natalizumab has been pulled from the market for treatment of MS because of unacceptable risk for a viral brain infection called progressive multifocal leukoencephalopathy, or PML. Sorry I don't have the time right now to edit the page but perhaps someone else can. I'll check back later... — Preceding unsigned comment added by Crazyflag (talk • contribs) 21:39, 15 February 2012 (UTC)

It was returned to the market, because it was regarded as useful despite the (small but non-zero) risk of PML. I have just scanned Google News and have not found anything to suggest that the drug was again withdrawn. JFW | T@lk 21:57, 15 February 2012 (UTC)

Tests for JCV virus are done before you get it nowadays. I find it remarkably coincidental that Tysabri causes Roseola outbreaks. All supposition, but isn't it strange that you should see a manifestation of HHV-6 viral activity during treatment with this drug?89.100.48.115 (talk) 19:41, 18 May 2012 (UTC)

Not autoimmune?

Peotrovitch (talk · contribs) changed the intro to reflect that claim that the role of autoimmunity in MS is questioned. This was based (according to the edit summary) on this news report in which scientists discuss their findings from doi:10.1038/nn.3062. This study has not appeared in print yet. According to the abstract, it was an in vivo mouse study that mainly looked at what happened if you killed oligodendrocytes and whether this would trigger anti-myelin immunity. The authors must have good reason to extrapolate these findings in their press releases, but I don't think we can say that it displaces 1000s of previous studies without a very strong secondary source. JFW | T@lk 11:19, 29 February 2012 (UTC)

Kmeadus (talk · contribs) added the following to "Management of the effects of MS":

“ It is important that people with MS realize that physical activity is not the cause of relapses. Research is being done to explore high- intensity or high-volume exercise and the corresponding training effects on physical function and disease activity in patients with MS prospectively. ”

This is based on the source doi:10.1177/1352458511415143, which is a primary research study looking at sports participation and relapse of MS. It is a retrospective observational study. I don't think it is suitable to support the claims made on the basis of relative methodological weakness, and we should only use a WP:MEDRS-compatible secondary source to support such a claim. The text also contains editorialising phrases ("it is important that [patients] realize"). JFW | T@lk 13:01, 13 March 2012 (UTC)

Good call. I was going to make the same point and roll back the edit but you beat me to it. Dubbin^{u | t | c} 20:59, 13 March 2012 (UTC)

Great minds edit alike. JFW | T@lk 09:30, 14 March 2012 (UTC)

Reply to User:Jfdwolff. Recently I have begun to believe that MS is in fact not an autoimmune disease and I have serious problems finding literatur that prove that it would primarily be an autoimmune disease. Do you have any good articles that can at least supply me with some evidence. To me i seems more logic that it would primarily be a neurodegenerative disorder with secondary inflammation. Alas, there is no answers. Please read Trapp and Nave 2008 , it is an eye-opener. Unsigned by Physician89 (talk · contribs)

Fascinating. The DOI is doi:10.1146/annurev.neuro.30.051606.094313. Without reading the article (no access), it is difficult to understand why someone would recover fully from a relapse if the main pathology is degenerative. Even if the primary insult is degenerative, the predominanat pathology still seems to be inflammatory. JFW | T@lk 08:38, 10 December 2012 (UTC)

I guess it's because it appears contraintuitive that it have taken a while get to this point. Of course inflammation is a big part of the patients life and there is a consensus around the fact that inflammation is the cause of the exacerbation/relapse. But treatment of the inflammation does not appear to affect the progression of the disease as much as it does in other autoimmune diseases. What correlates better to progression is the degenerative aspects such as volume loss and axonal degradation. Most of the long-term disabilty cannot be explained by pure inflammation, it could be explained by irrepairable damage done by previous inflammation of course. The question that no one has an answer to is whether inflammation causes this process or if the inflammation is a patient's response to the degradation. Assuming it is the response then the primary progressive MS patient is the ideal patient as he/she has no inflammatory response. This fits well because on a population level PPMS is more common in the higher ages. Also when relapse-remitting patients transform into secondary progression the inflammatory aspects of the disease often stops, this often roughly occure at the same age when PPMS patients typically present. The hypothesis therefore is that something happens in the brain during the relapse-remitting phase that a majority respond to with inflammation. The inflammation might be beneficial in the future when treatment is available for the degeneration because it allows for earlier diagnosis. Anyway, this are all just a hypothesis and should not confuse people and should not appear on the front of the MS wikipage. What could be done is to downtone the autoimmunity though. Physician89 (talk) 23:31, 13 December 2012 (UTC)

Prognosis

Surely there are more recent articles on prognosis than the studies done inthe 1980s before the widespread use of interferons? --5telios (talk) 11:58, 20 March 2012 (UTC)

Interferons only diminish relapse rates but there is no data to suggest that they delay progression. JFW | T@lk 21:55, 20 March 2012 (UTC)

Etiology

The cause of MS has been sought after for a long time. Has anyone added a section on this? I'm fairly sure it's viral, caused by the HHV-6a virus, though some studies dispute this. There are lots of anti viral compounds available from nature. Papers are still being reviewed. Etiology of MS should include EBV, HHV-6, CCSVI (though this can be caused by HHV-6), lack of vitamin D, irregular sleep patterns (maybe) and genetics. Where you live makes a difference too. Shtanto (talk) 18:13, 22 May 2012 (UTC)

Did you consider reading the "Causes" section of the article? Simply put, the experts acknowledge that it is still idiopathic. We don't do research here, we summarize what the best available sources have published. LeadSongDog come howl! 19:39, 22 May 2012 (UTC)

Your personal convictions are of little relevance, and the data on CCSVI is very doubtful. Secondary sources, as LeadSongDog says, are the only suitable sources for a topic like this, and etiologies not listed in such sources are very unlikely to be relevant for the general reader.

I do object to using the Cochrane Collaboration as a source when it comes to etiology. Cochrane studies treatments, not pathophysiology, and their classification is not in itself authoritative. JFW | T@lk 21:35, 22 May 2012 (UTC)

Objection noted. What alternative secondary sources would you suggest as reliable current information for that aspect? LeadSongDog come howl! 15:38, 23 May 2012 (UTC)

Any recent review article on the condition will make some allusions to its suspected aetiopathological mechanism. There are several already cited. JFW | T@lk 21:48, 24 May 2012 (UTC)

Edit request on 25 May 2012

I want to edit a new external link which will be helpful to people searching for information about multiple sclerosis. The link is http://www.lifeandms.com/

ALRstark (talk) 13:17, 25 May 2012 (UTC)

 Not done As it's a commercial website of a pharmaceutical company. Dru of Id (talk) 19:19, 25 May 2012 (UTC)

Educational Reading

Oliver J. DeSofi, author of Caregiving: My Story, Your Guide (Dec 2010)This book describes the 24 year documented progression of an MS patient and the personal experiences of her caregiver husband.Seidler1 (talk) 15:42, 27 June 2012 (UTC)

Okay and? Doc James (talk · contribs · email) (please reply on my talk page) 16:59, 27 June 2012 (UTC)

Brand names

I would prefer to have everyone use generic names

But it's a fact of life that doctors, patients and others regularly refer to drugs by their brand names. Even the medical journals use brand names. The NEJM used "BG-12", not "dimethyl fumarate".

WP:MEDMOS says, "Write for the average reader and a general audience—not professionals or patients."

If we eliminate the brand names, non-specialist readers will have a more difficult time understanding this article. Having to click to another article to understand the first article is also difficult.

Some drugs may have different brand names in different countries, and I don't think we should use long lists of drug names in many countries, but we can and should use the most common names in English-speaking countries, and many of the drugs have only one brand name. --Nbauman (talk) 21:20, 27 September 2012 (UTC)

Most meds have dozens of brand names. They should be listed on the page for that med not within the articles themselves IMO. Drug reps of course refuse to use anything but brand names. Most of the time we should simply be using the classes of medications followed by a generic name of one or two meds within that class in the main article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:16, 27 September 2012 (UTC)

BG-12 is not really a brand name but an investigational compound name. Interestingly some drugs continue to be called by their investigational name well after they have acquired generic and brand names. TK506 and STI571 are good examples. JFW | T@lk 22:20, 27 September 2012 (UTC)

Some people are more familiar with the brand name than with the generic name. Would you agree with that?

Question: Will it be easier for the general reader to understand this passage if we add the most common brand names for these drugs, or will it be more difficult?

Will it be easier for the general reader to understand this passage if he doesn't have to click a link to another page? --Nbauman (talk) 07:04, 28 September 2012 (UTC)

There are more than 2000 brand names for acetaminophen / paracetamol. There are people for which each individual brand name is more familiar. We do not add all 2000 brand names every time we mention acetaminophen. Yes this is an extreme example but most meds have at least 10 brand names.

But to answer your question adding all these brand names clutters the text and thus IMO makes the text less understandable. Than their is the potential harm in that different brand names may indicated different generic meds is different countries (deaths have resulted from where a person with a prescription containing a brand name went to another country handed it to the pharmacist was given what the brand name was in that country and not what it was in his home country. Other issues with brand names is that they increase costs and confuse both patients and physicians (the least we at Wikipedia can do is not perpetuation their use within our articles on disease) Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:42, 28 September 2012 (UTC)

I once strongly opposed the use of brand names because, as you said, brand marketing increases the cost and is inherently promotional. However, I had to give up. I was forced to acknowledge that some brand names are so popular among both medical professionals of all kinds and the general public (the target audience for Wikipedia) that they won't know what I'm talking about if I only use generics rather than using both. For example, the acronyms for chemotherapy protocols don't make sense if you refer to Adriamycin only as doxorubicin.

For most of these MS drugs there is only one common brand name, and that's all we need to use. Referring to natalizumab in the JAMA style book style as "natalizumab (Tysabri)" doesn't clutter the text or make it less understandable. If the reader is familiar with the name Tysabri but not natalizumab, as many are, it makes the text more understandable. The alternative, of clicking on every generic name until you find out which one is Tysabri, is certainly more difficult and confusing.

Question: Do you think that, for readers who are more familiar with the brand name than the generic name, it will clutter the text and make it more or less understandable to have the most common brand name along with the generic, as "natalizumab (Tysabri)"? --Nbauman (talk) 22:50, 28 September 2012 (UTC)

If we use two names only when it is commonly done in other authoritative sources then I don't see us creating a problem unless I'm missing something. Biosthmors (talk) 23:49, 28 September 2012 (UTC)

Possible reference

There is an interesting paper on how natural or man-made electrical fields might be involved through dielectrophoretic forces on the protein lipids of the myelin, which may be worth including. The study of the influence of atmospheric electromagnetic factors on human health is beginning to grow rapidly. Canbay C “The essential environmental cause of multiple sclerosis disease” PIER (Progr In Electromagnet Res.) 101: 375-391; (2010) http://www.jpier.org/PIER/pier101/25.09112604.pdf Diagnostic2 (talk) October 28th, 2012. —Preceding undated comment added 18:01, 28 October 2012 (UTC)

See WP:MEDRS. Electromagnetism is not considered an important factor in MS. WP:WEIGHT applies for this. JFW | T@lk 23:40, 28 October 2012 (UTC)

Who has studied electromagnetism as regards MS and has therefore concluded it is not important? If this is a new area of study it may not yet be possible to tell how important it will turn out to be. Canbay's mathematical support for dielectrophoretic lipid disruption of myelin looks worthy of further investigation. Diagnostic2 (talk) October 29th 2012. —Preceding undated comment added 11:20, 29 October 2012 (UTC)

Overcoming Multiple Sclerosis (book written by prof. George Jelinek)

I am surprised that this book, written by professor of emergency medicine George Jelinek, isn't mentioned anywhere here although it summarizes a great deal of evidence about health benefits of low saturated fat diet and high doses of Vitamin D. Is there any reason for that? I can't believe that wikipedia contributors aren't aware of this book... Riose (talk) 19:06, 5 November 2012 (UTC)

ISBN 1742371795 - the main perspectives in this book, at least judging from the Amazon write-up, are quite significantly at odds with current professional recommendations. I would have difficulty quoting from it without some sort of secondary source supporting its acceptance as a legitimate opinion. JFW | T@lk 21:07, 5 November 2012 (UTC)

Well, I have read this book and it contains a very good summary of currently available 'alternative' treatments. It's just not one of those believe-in-something-and-it-will-come-true books, the author cites literaly hundreds of papers published in respectable journals. He himself publishes in respectable journals. So if you don't mind, I'll mention this book on "Treatment of multiple sclerosis" page, just after Swank Multiple Sclerosis Diet.Riose (talk) 12:07, 6 November 2012 (UTC)

You don't need my permission, but consensus would be good. JFW | T@lk 22:12, 6 November 2012 (UTC)

Major Contradiction

Early in the article it states "Decreased sunlight exposure has been linked with a higher risk of MS.[17] Decreased vitamin D production and intake has been the main biological mechanism used to explain the higher risk among those less exposed to sun."[17][18][19]

Where as in: Epidemiology it states There is a north-to-south gradient in the northern hemisphere and a south-to-north gradient in the southern hemisphere, with MS being much less common in people living near the equator.[1][66] Climate, sunlight and intake of vitamin D have been investigated as possible causes of the disease that could explain this latitude gradient....A relationship between season of birth and MS has also been found which lends support to an association with sunlight and vitamin D.

For example fewer people with MS are born in November as compared to May.[68] Please correct. — DocOfSoc • Talk • 04:26, 23 November 2012 (UTC) — DocOfSoc • Talk • 04:18, 24 November 2012 (UTC)

Both these mean the same thing. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:34, 23 November 2012 (UTC)

WRONG!!! Read it again! — DocOfSoc • Talk • 04:18, 24 November 2012 (UTC)

If you are born in Nov your mother was exposed to sunlight during much of your gestation. If you are born in May your mother was exposed to little sunlight during your gestation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:03, 24 November 2012 (UTC)

That's only correct for the northern hemisphere. The majority of the world's population is in that hemisphere, but that's a rather weak justification. It would be better to say "If you are born in autumn your mother was exposed to sunlight... If you are born in spring your mother was exposed to little sunlight...".-gadfium 05:15, 24 November 2012 (UTC)

Agree it could be clearer. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:42, 24 November 2012 (UTC)

Proposal. Change naming for section "Classification"

The section "Classification" refers specifically to the clinical classification, as opposed to possible pathological classifications currently under research. I propose to change the section's name for "Clinical classification" or better "Clinical courses".

--Juansempere (talk) 15:30, 14 December 2012 (UTC)

I will perform the change now. If anybody disagrees, just revert it.

--Juansempere (talk) 01:29, 17 December 2012 (UTC)

Include new Phase 3 study: alemtuzumab

Under "Research", alemtuzumab has now had 2 clinically significant phase 3 trials published in the Lancet in Nov 2012, so it should be changed to say that it has been tested in a phase 3 trial; I have written about these under the 'CD52' wiki page which could be linked at this point, saying for example: "A number of treatments that may curtail attacks or improve function are under investigation. Emerging agents for RRMS that have shown promise in phase 2 trials include daclizumab (trade name Zenapax), rituximab, dirucotide, BHT-3009, cladribine, dimethyl fumarate, estriol, laquinimod, PEGylated interferon-β-1a,[78] minocycline, statins, temsirolimus and teriflunomide.[77] A phase 3 trial in November 2012 demonstrated some clinical benefit from alemtuzumab (trade name Campath), which targets CD52". Remd104 (talk) 00:44, 29 December 2012 (UTC)

Except the manufacturer of Campath is trying to stop it from being authorised for this indication. How about we wait for a secondary source, which shouldn't be long in coming? JFW | T@lk 23:59, 29 December 2012 (UTC)

Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template..--Canoe1967 (talk) 00:03, 30 December 2012 (UTC)

I agree, new studies are good, but the page remains factually incorrect in stating that alemtuzumab remains a phase 2 study drug: there are now 2 phase 3 studies on it. There are concerns that the manufacturer of Campath is considering increasing the price but going to do so in negotiation with organisations such as NICE, but I wasn't aware that the manufacurer was trying to stop it being authorised?— Preceding unsigned comment added by Remd104 (talk • contribs) 29 December 2012

I am setting this edit request back to "answered" in light of the above response from Jfdwolff (talk · contribs). You are welcome to continue discussion on this talk page to build consensus, but please do not re-activate the edit request unless there is consensus for this edit. —KuyaBriBri^Talk 15:55, 2 January 2013 (UTC)

Yes there are review articles that put new meds in proper perspective. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:39, 2 January 2013 (UTC)

Seems I was wrong about the licensing: the manufacturer seems to have applied for a license with EMEA[1]. JFW | T@lk 23:21, 2 January 2013 (UTC)

"The blood–brain barrier is a capillary system"

The blood–brain barrier IS NOT a capillary system this must be corrected. Easy to verify Blood–brain barrier Nini00 (talk) 09:50, 30 January 2013 (UTC)

I have changed the article to: The blood–brain barrier is a part of the capillary system that prevents the entry of T cells into the central nervous system.--Garrondo (talk) 11:08, 30 January 2013 (UTC)

Historical cases

Clive Burr: [2] — Preceding unsigned comment added by SFtheGreat (talk • contribs) 19:36, 13 March 2013 (UTC)

Dimethyl fumarate

Just I would like to add that there is new drug approved for MS. US Food and Drug Administration (FDA) has approved dimethyl fumarate (Tecfidera, Biogen Idec) for the treatment of relapsing-remitting multiple sclerosis (MS). Mar 27, 2013 citation- http://www.medscape.com/viewarticle/781450?src=wnl_edit_newsal&uac=167846CN — Preceding unsigned comment added by 70.44.253.137 (talk) 01:19, 29 March 2013 (UTC)

Images

Animation created from a a 1887 photographic study of locomotion of a MS male patient with walking difficulties by Muybridge

Photographic study of locomotion of a MS female patient with walking difficulties created in 1887 by Muybridge

These two images are the same. Thus IMO we only need the one. Maybe which everyone it is should be in the history section as it fits better there. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:56, 2 June 2013 (UTC)

They are two different patients, and have different symptoms, as the female has clear spasticity problems in hands while male has mainly walking problems. Moreover, I purpousedly left one as created, and animated the other one so as to emphasize walking difficulties in the first, and historical aspects in the second. I disagree that they fit better in history section: symptoms depicted are still valid today, specially since there are not any free videos of an MS patient available showing motor symptoms. I would rather leave the two until there is a better image for the symptoms section. If I had to choose I would leave the animated one in the symptoms section, since the author made no special contributions to the study of MS (only potographs of the 2 patients shown and a third one) so the historical value is only as a curiosity. Also, animation has taken 3 hours of work and IMO has greater medical value. --Garrondo (talk) 21:22, 2 June 2013 (UTC)

Okay sounds reasonable. Adjusted formatting abit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:25, 2 June 2013 (UTC)

Comments

• We discuss pathophysiology twice in the lead.

You have fixed it, havent you?.--Garrondo (talk) 15:44, 3 June 2013 (UTC)

• With respect to signs and symptoms while any can happen nearly it would be useful to know which are more common.

Point is that being lesions semi random all commented are quite common. I would nevertheless try to find some data on prevalence of symptoms.--Garrondo (talk) 15:44, 3 June 2013 (UTC)

For example Compston lancet article is similarly unspecific: In most patients, clinical manifestations indicate the involvement of motor, sensory, visual, and autonomic systems but many other symptoms and signs can occur (table). Few of the clinical features are disease-specific, but particularly characteristic are Lhermitte's symptom (an electrical sensation running down the spine or limbs on neck flexion) and the Uhthoff phenomenon (transient worsening of symptoms and signs when core body temperature increases, such as after exercise or a hot bath).--Garrondo (talk) 15:50, 3 June 2013 (UTC)

• Not sure about the need to contain the complicated term, maybe just link to it? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:10, 3 June 2013 (UTC)

I am not following you: which word?--Garrondo (talk) 15:44, 3 June 2013 (UTC)

Just the changes I made. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 3 June 2013 (UTC)

Regarding the EDSS comment on my talk page: I have searched for the term in pubmed and from the first abstracts I have found it appears capitalized in half of them, so probably it does not really matter as long as we are systematic.

--Garrondo (talk) 15:44, 3 June 2013 (UTC)

Okay. We at Wikipedia seem to capitalize rarely. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 3 June 2013 (UTC)

• There's a spelling error in the first paragraph. "Disease is more common in women and the onset tipically occurs in young adults" should read "Disease is more common in women and the onset typically occurs in young adults".--StuartLivings 06:56 5 June 2013 (UTC)

Thanks a lot for your comment. Corrected.--Garrondo (talk) 09:18, 5 June 2013 (UTC)

• Any chance someone could mention Low-Dose Naltrexone? It does work you know.

I deem myself qualified by virtue of Patientibus Cognesemus, but my latin is rubbish. Living with MS is like trying to live with a wetsuit on. The mask blurs your vision, the snorkel and regulator fumble your speech, the wetsuit is too tight around the middle, it's drying out so you're stiff all the time, you're tired from simply trying to move and breathe with the heavy tanks on your back, the flippers stymie your steps and throw you off balance. I took half dose Minocycline for 3 months. It might have been little more than a placebo effect, but it seemed to be doing something. One thing you should know about MS: it makes you fight like a cornered animal.Shtanto (talk) 20:43, 3 February 2014 (UTC)

We need refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:08, 3 February 2014 (UTC)

Heading

1. Would not call this press release a reliable source for what it is supporting [3]. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:10, 8 June 2013 (UTC)

It is used 5 times. Twice for when it was approved and once for frequency of administration. I would say that it is fairly reliable for those 3 statements since they are non-controversial. I am going to try to find a review for the other two.--Garrondo (talk) 06:55, 9 June 2013 (UTC)

Done: found secondary source for secondary effects (We already had them in the article).--Garrondo (talk) 07:22, 9 June 2013 (UTC)

1. Also this does not look alike a reliable source [4]Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:18, 8 June 2013 (UTC)

Agreed. I will take a look on whether Compston sorce supports both statements.--Garrondo (talk) 06:55, 9 June 2013 (UTC)

It is indeed supported by the Compston source. Eliminated the other source.--Garrondo (talk) 06:57, 9 June 2013 (UTC)

1. What is an "unstable bladder" due you mean urinary incontinence?

Yes, it was called as such in the original source.--Garrondo (talk) 06:55, 9 June 2013 (UTC)

1. Not sure about "while management of many others is much more complicated". Do you mean that effective treatment does not exist for some symtoms?Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:39, 8 June 2013 (UTC)

Yes.--Garrondo (talk) 07:27, 9 June 2013 (UTC)

Again, autoimmune or idiopatic?

Again, in the lead is asserted that MS is autoimmune, which is in fact supported by a lot of sources, but as far as I know there is also a lot of sources saying that it is idiopatic or challenging the autoimmunity hipothesis. The reference to the autoimmunity or at least a remark about the disagreement should be stated.

Just to support my point, here is a recent review questioning the primary autoimmunity [5]

Juansempere (talk) 22:02, 10 June 2013 (UTC)

Is there a pubmed indexed source? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:55, 11 June 2013 (UTC)

Clarified. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:02, 11 June 2013 (UTC)

I see 2014 reviews classifying it as autoimmune. I will post them here and we can discuss further if needed. TylerDurden8823 (talk) 07:58, 12 October 2014 (UTC)

Lede re infections

At this edit Doc James tweaked the wording, but it still seems not quite right. Surely the intended factor in the source isn't just whether someone is environmentally exposed to the agent so much as whether they are (to some extent) infected by it. Am I missing a subtlety of definition here? If so, I suspect many readers will miss it too. LeadSongDog come howl! 14:20, 13 June 2013 (UTC)

Adjusted further. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:42, 14 June 2013 (UTC)

Image

I am of the opinion that this image does not add enough and thus should be removed. We already have one image in this section and one that is more specific at that. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:58, 14 June 2013 (UTC)

I would rather have the two, but since you have been the second person to raise the issue and it is quite reasonable, I have eliminated it myself.--Garrondo (talk) 19:42, 14 June 2013 (UTC)

Thanks Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:06, 16 June 2013 (UTC)

Relapses

Were in the source does it state the relapse rate is rarely greater than 1.5 per year? "Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above one and a half per year." pmid18970977 Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:31, 16 June 2013 (UTC)

Section clinical course: New episodes occur erratically but the rate seldom exceeds 1·5 per year. With time, recovery from each episode is incomplete and persistent symptoms accumulate.--Garrondo (talk) 07:25, 17 June 2013 (UTC)

I do not get the fraction. Are they not discrete integers? How does one have 1.5 acute episoids? Should it not be either 1 or 2? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:13, 17 June 2013 (UTC)

It says that the mean number of episodes in a year for a normal individual is 1.5. Obvioulsy an individual a specific year will have 1 or 2 but not 1.5. --Garrondo (talk) 11:27, 17 June 2013 (UTC)

Edit request on 22 June 2013

Subsection 2.2, Paragraph 3: "An explanation for this could be that some kind of infection, produced by a widespread microbe rather than a rare one, is the origin of the disease.[6] Proposed mechanisms, including the hygiene hypothesis and the prevalence hypothesis. The hygiene hypothesis proposes..." I got caught up on the incomplete sentence, but otherwise, great read! Ril3yj1mes (talk) 08:32, 22 June 2013 (UTC)

Done Yes. I think it was intended to read: "Proposed mechanisms include the hygiene hypothesis and the prevalence hypothesis.", because the 2 following sentences proceed to elaborate on these hypotheses. I changed it accordingly. Thank you for pointing it out. Begoon ^talk 10:17, 22 June 2013 (UTC)

Edit request on 22 June 2013

Please note there are spelling errors in the 5th paragraph of the text: "symptoms usually appear in episoids of sudden worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups") or gradually over time with worsening neurologic function.[5] A combination of these two parterns may also occur.[5]. "episoids" should read "episodes" and "parterns" should read "patterns"

Best wishes.AppGirl (talk) 22:46, 22 June 2013 (UTC)AppGirl AppGirl (talk) 22:46, 22 June 2013 (UTC)

Fixed. Thanks.-gadfium 22:50, 22 June 2013 (UTC)

Pathophysiology

In this section with present the autoimmunity theory as fact while more recent refs state that it could also be from primary failure of the myelin-producing cells. The pathophsiology sections needs to be updated to reflect this uncertainty. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:46, 30 June 2013 (UTC)

Pathophysiology is not my strong point, so if you could fix it it would be great. Nevertheless, (from what I have read) there have always been some experts that do not believe in the autoimmunity theory, and on the other hand it is fairly proven that there is a (main) autoimmune component per the efficacy of autoimmune thereapies.

On the other hand I have just noticed that in January content based in primary sources and probably overly specific was introduced in this section leading to a hardly understandable paragraph in this section, which now that I re-read it has several problems. I believe that we should look for a review of autoimmunology and MS and use it to rewrite the section. I paste here the text of the article as it is now and the problems I see in it. Not sure if in the mean time is better to leave it in the article or simply eliminate it. I do not know how I could I not notice it when I reviewed the full article recently. --Garrondo (talk) 07:22, 3 July 2013 (UTC)

Content commented

Possible targets of the immune response include myelin basic protein (MBP) and proteolipid protein (PLP).

The commonly prescribed MS drug glatiramer acetate was designed to mimic MBP and therefore act as a decoy for autoreactive immune cells. Not really relevant as it is writen right now.

Even so, the role of MBP in MS is controversial as it is buried within the myelin sheath (rather than on the surface), where immune cells would not be able to recognize it.

Recent data suggest a role for myelin lipids in MS. Secondary source needed

Historically, researchers have assumed the myelin target was a protein, even though the myelin sheath is nearly 80% lipid.

Furthermore, lipids are known to be the target of another prominent nervous system autoimmune condition, Guillain-Barre syndrome.Not really relevant as it is writen right now.

Whether the autoantigen is a protein or a lipid, autoimmunity may arise when immune cells recognizing a foreign antigen cross-react with self antigens, known as molecular mimicry. Secondary source needed

Comments or any help to improve it would be great. --Garrondo (talk) 07:22, 3 July 2013 (UTC)

References

Agree. I hate writing pathophysiology. Am working on the geography as a cause right

now.Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:09, 3 July 2013 (UTC)

I see what I can do...--Garrondo (talk) 08:34, 3 July 2013 (UTC)

While I am still reorganizing the section I have eliminated content based in primary sources and moved the most basic contents to a recently created intro. I feel it fits better since plaques and inflammation are both related to immunological processes so it may make more sense to not have an autoimmunology section on itself, but a short intro later developed in each of the two subsections. --Garrondo (talk) 11:55, 5 July 2013 (UTC)

Global map

We could use a global map of MS prevalence such as the one here on page 15 from WHO [6] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:22, 3 July 2013 (UTC)

Have made a request to a map maker here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:25, 3 July 2013 (UTC)

Great... Nevertheless it might look a bit cluttered with the map in the previous section. --Garrondo (talk) 06:45, 3 July 2013 (UTC)

Wording

IMO we need simplified wording, especially in the lead. I would not call "Causal hypotheses" simple and beleive that many reading it will not understand what it means [7]. How about "proposed causes"? Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:36, 3 July 2013 (UTC)

Works for me. Ward20 (talk) 08:48, 3 July 2013 (UTC)

Research section

I have tried to simplify and summarize this section. Much of it IMO was and some of it still is too complicated for a general overview article. I struggled to understand some of it. Have moved parts to the subarticle of which I changed the name to be more encompassing of all research topics. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:22, 5 July 2013 (UTC)

This paper does not appear to be a proper review article [8]. It is just some research guessing what is going to happen in the future. I am not a big fan of adding predictions of the future to Wikipedia as most are wrong and it is an impossible endeavor most of the time. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:02, 5 July 2013 (UTC)

It is a secondary source in which predictions taking into account existing research are made. Of course the may be wrong, but that is not our problem: it is still useful as the scientific opinion on what is going to be be the future of MS and MS research. I would say that it is adequate for a section called "research directions" as long as it is especifified that "experts predict..".Nevertheless with the simplification you have made in the section I believe it is given much less weight. --Garrondo (talk) 07:24, 9 July 2013 (UTC)

Source review

For your sourcing review pleasure... Zad68 14:21, 5 July 2013 (UTC)

In this table:

• Source lists the source as cited in the article
• Seems WP:RS? means, "Does this source appear to meet WP:RS for reliable sourcing?"
• Use OK? means, is the source used appropriately in the article? For the review, a few selected sources will be spot-checked to ensure they aren't plagiarized and support the article content. "?" indicates the source was not spot-checked.
• Notes will summarize problems found and what needs to be done to fix them

Source	Seems WP:RS?	Use OK?	Notes
<ref>{{cite journal|last=Nakahara|first=J|coauthors=Maeda, M; Aiso, S; Suzuki, N|title=Current concepts in multiple sclerosis: autoimmunity versus oligodendrogliopathy.|journal=Clinical reviews in allergy & immunology|date=2012 Feb|volume=42|issue=1|pages=26–34|pmid=22189514|}}</ref>	?	?	PMID 22189514: Review
<ref name="pmid18970977">{{cite journal |author=Compston A, Coles A |title=Multiple sclerosis |journal=Lancet |volume=372 |issue=9648 |pages=1502–17 |year=2008 |month=October |pmid=18970977|doi=10.1016/S0140-6736(08)61620-7 |url=}}</ref>	?	?	PMID 18970977: (unspecified, possibly primary) I have crossed comment: probably the best review we have.--Garrondo (talk) 07:35, 9 July 2013 (UTC)
<ref>{{cite book|title=Bradley's neurology in clinical practice.|year=2012|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=1-4377-0434-4|edition=6th ed.|author=Murray ED, Buttner EA, Price BH|editor=Daroff R, Fenichel G, Jankovic J, Mazziotta J|chapter=Depression and Psychosis in Neurological Practice}}</ref>	?	?	Professional book: secondary.--Garrondo (talk) 07:35, 9 July 2013 (UTC)
<ref>{{cite journal |author=Kurtzke JF |title=Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) |journal=Neurology |volume=33 |issue=11 |pages=1444–52 |year=1983 |pmid=6685237|doi=10.1212/WNL.33.11.1444 }}</ref>	?	?	PMID 6685237: primary, but it is the original publication of the EDSS (Seminal paper) --Garrondo (talk) 07:35, 9 July 2013 (UTC)
<ref name="pmid10467378">{{cite journal |author=Amato MP, Ponziani G |title=Quantification of impairment in MS: discussion of the scales in use |journal=Mult. Scler. |volume=5 |issue=4 |pages=216–9 |year=1999 |month=August |pmid=10467378|doi= |url=}}</ref>	?	?	PMID 10467378: Comparative Study, Review
<ref name="pmid12356200">{{cite journal |author=Rudick RA, Cutter G, Reingold S |title=The multiple sclerosis functional composite: a new clinical outcome measure for multiple sderosis trials |journal=Mult. Scler. |volume=8 |issue=5 |pages=359–65 |year=2002 |month=October |pmid=12356200|doi= |url=}}</ref>	?	?	PMID 12356200: Review, Validation Studies
<ref name="pmid8780061">{{cite journal|author=[[Fred D. Lublin|Lublin FD]], Reingold SC|title=Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis|journal=Neurology |volume=46 |issue=4|pages=907–11|year=1996|month=April|pmid=8780061|doi=10.1212/WNL.46.4.907}}</ref>	?	?	PMID 8780061: (unspecified, possibly primary): Classification of subtypes still used
<ref name="pmid16804331">{{cite journal|author=Tataru N, Vidal C, Decavel P, Berger E, Rumbach L |title=Limited impact of the summer heat wave in France (2003) on hospital admissions and relapses for multiple sclerosis |journal=Neuroepidemiology |volume=27 |issue=1 |pages=28–32 |year=2006|pmid=16804331|doi=10.1159/000094233}}</ref>	?	?	PMID 16804331: (unspecified, possibly primary)
<ref name="pmid17439878">{{cite journal|author=Heesen C, Mohr DC, Huitinga I, ''et al.''|title=Stress regulation in multiple sclerosis: current issues and concepts|journal=Mult. Scler.|volume=13 |issue=2 |pages=143–8 |year=2007 |month=March |pmid=17439878|doi=10.1177/1352458506070772}}</ref>	?	?	PMID 17439878: Review
<ref name="pmid11205361">{{cite journal|author=Martinelli V |title=Trauma, stress and multiple sclerosis |journal=Neurol. Sci. |volume=21|issue=4 Suppl 2 |pages=S849–52|year=2000 |pmid=11205361|doi=10.1007/s100720070024 |url=http://link.springer-ny.com/link/service/journals/10072/bibs/00214%20Suppl%202/0021S849.htm}}</ref>	?	?	PMID 11205361: Review
<ref name="pmid12127652">{{cite journal |author=Pugliatti M, Sotgiu S, Rosati G |title=The worldwide prevalence of multiple sclerosis |journal=Clin Neurol Neurosurg |volume=104 |issue=3 |pages=182–91 |year=2002 |month=July|pmid=12127652|doi=|url=}}</ref>	?	?	PMID 12127652: Review
<ref name="pmid20494325">{{cite journal |author=Ascherio A, Munger KL, Simon KC |title=Vitamin D and multiple sclerosis|journal=Lancet Neurol |volume=9 |issue=6 |pages=599–612 |year=2010 |month=June |pmid=20494325|doi=10.1016/S1474-4422(10)70086-7 }}</ref>	?	?	PMID 20494325: Review
<ref name="pmid19897699">{{cite journal |author=Kulie T, Groff A, Redmer J, Hounshell J, Schrager S|title=Vitamin D: an evidence-based review |journal=J Am Board Fam Med |volume=22 |issue=6 |pages=698–706 |year=2009|pmid=19897699|doi=10.3122/jabfm.2009.06.090037 |url=}}</ref>	?	?	PMID 19897699: Review
<ref name="pmid14747002">{{cite journal|author=Dyment DA, Ebers GC, Sadovnick AD |title=Genetics of multiple sclerosis |journal=Lancet Neurol|volume=3|issue=92|pages=104–10|year=2004|month=February|pmid=14747002|doi=10.1016/S1474-4422(03)00663-X}}</ref>	?	?	PMID 14747002: Review
<ref>{{cite journal|last=Hassan-Smith|first=G|coauthors=Douglas, MR|title=Epidemiology and diagnosis of multiple sclerosis.|journal=British journal of hospital medicine (London, England : 2005)|date=2011 Oct|volume=72|issue=10|pages=M146-51|pmid=22041658|}}</ref>	?	?	PMID 22041658: Review
<ref name="pmid11603614">{{cite journal|author=Rosati G|title=The prevalence of multiple sclerosis in the world: an update|journal=Neurol. Sci.|volume=22|issue=2|pages=117–39|year=2001|month=April|pmid=11603614|doi=10.1007/s100720170011}}</ref>	?	?	PMID 11603614: Review
<ref name="pmid21247752">{{cite journal |author=Baranzini SE |title=Revealing the genetic basis of multiple sclerosis: are we there yet? |journal=Curr. Opin. Genet. Dev. |volume=21 |issue=3 |pages=317–24 |year=2011 |month=June|pmid=21247752|pmc=3105160 |doi=10.1016/j.gde.2010.12.006 |url=}}</ref>	?	?	PMID 21247752: Review
<ref name="pmid15721830">{{cite journal|author=Gilden DH|title=Infectious causes of multiple sclerosis|journal=[[The Lancet Neurology]]|volume=4|issue=3|pages=195–202|year=2005|month=March|pmid=15721830|doi=10.1016/S1474-4422(05)01017-3}}</ref>	?	?	PMID 15721830: Review
<ref name="pmid18219824">{{cite journal |author=Spitsin S, Koprowski H |title=Role of uric acid in multiple sclerosis |journal=Curr. Top. Microbiol. Immunol. |volume=318 |issue= |pages=325–42 |year=2008 |pmid=18219824|doi= |url=}}</ref>	?	?	PMID 18219824: Review
<ref name="pmid11955556">{{cite journal|author=Compston A, Coles A|title=Multiple sclerosis|journal=Lancet|volume=359|issue=9313|pages=1221–31|year=2002|month=April|pmid=11955556|doi=10.1016/S0140-6736(02)08220-X}}</ref>	?	?	PMID 11955556: Review
<ref name="pmid17531860">{{cite journal |author=Chari DM |title=Remyelination in multiple sclerosis|journal=Int. Rev. Neurobiol. |volume=79 |issue= |pages=589–620 |year=2007 |pmid=17531860|doi=10.1016/S0074-7742(07)79026-8 |url=}}</ref>	?	?	PMID 17531860: Review
<ref name="pmid17351524">{{cite journal |author=Pittock SJ, Lucchinetti CF |title=The pathology of MS: new insights and potential clinical applications |journal=Neurologist|volume=13 |issue=2 |pages=45–56 |year=2007 |month=March |pmid=17351524|doi=10.1097/01.nrl.0000253065.31662.37 }}</ref>	?	?	PMID 17351524: Review
<ref name="pmid11794488">{{cite journal|author=Trojano M, Paolicelli D|title=The differential diagnosis of multiple sclerosis: classification and clinical features of relapsing and progressive neurological syndromes |journal=Neurol. Sci. |volume=22 |issue=Suppl 2 |pages=S98–102 |year=2001 |month=November |pmid=11794488|doi=10.1007/s100720100044 |url=http://link.springer-ny.com/link/service/journals/10072/bibs/122%20Suppl%202000/122%20Suppl%2020S98.htm}}</ref>	?	?	PMID 11794488: Review
<ref name="pmid15177763">{{cite journal|author=Poser CM, Brinar VV |title=Diagnostic criteria for multiple sclerosis: an historical review |journal=Clin Neurol Neurosurg |volume=106 |issue=3 |pages=147–58 |year=2004|month=June |pmid=15177763|doi=10.1016/j.clineuro.2004.02.004}}</ref>	?	?	PMID 15177763: Biography, Historical Article, Portraits
<ref name="pmid11456302">{{cite journal|author=McDonald WI, Compston A, Edan G, ''et al.'' |title=Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis |journal=Ann. Neurol. |volume=50 |issue=1 |pages=121–7 |year=2001 |month=July |pmid=11456302|doi=10.1002/ana.1032}}</ref>	?	?	PMID 11456302: Guideline
<ref name="pmid16283615">{{cite journal|author=Polman CH, Reingold SC, Edan G, ''et al.''|title=Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria"|journal=Ann. Neurol.|volume=58|issue=6 |pages=840–6 |year=2005 |month=December |pmid=16283615|doi=10.1002/ana.20703}}</ref>	?	?	PMID 16283615: Review
<ref name="pmid18256986">{{cite journal|author=Rashid W, Miller DH|title=Recent advances in neuroimaging of multiple sclerosis|journal=Semin Neurol|volume=28|issue=1|pages=46–55|year=2008 |month=February|pmid=18256986|doi=10.1055/s-2007-1019127}}</ref>	?	?	PMID 18256986: Review
<ref name="pmid16945427">{{cite journal|author=Link H, Huang YM|title=Oligoclonal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness|journal=J. Neuroimmunol.|volume=180|issue=1–2|pages=17–28|year=2006|month=November|pmid=16945427|doi=10.1016/j.jneuroim.2006.07.006 }}</ref>	?	?	PMID 16945427: Review
<ref name="pmid10802774">{{cite journal |author=Gronseth GS, Ashman EJ |title=Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=54 |issue=9 |pages=1720–5 |year=2000 |month=May |pmid=10802774|doi=10.1212/WNL.54.9.1720|url=}}</ref>	?	?	PMID 10802774: Guideline, Practice Guideline, Review
<ref name="pmid18219812">{{cite journal |author=Pittock SJ, Rodriguez M |title=Benign multiple sclerosis: a distinct clinical entity with therapeutic implications |journal=Curr. Top. Microbiol. Immunol. |volume=318 |issue= |pages=1–17 |year=2008 |pmid=18219812|doi=10.1007/978-3-540-73677-6_1 |url=}}</ref>	?	?	PMID 18219812: Review
<ref>{{cite book|last=Feinstein|first=A|title=The clinical neuropsychiatry of multiple sclerosis|year=2007|publisher=Cambridge University Press|location=Cambridge|isbn=052185234X|page=20|edition=2nd ed.}}</ref>	?	?
<ref name="pmid15847841">{{cite journal|author=Miller D, Barkhof F, Montalban X, Thompson A, Filippi M|title=Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis|journal=Lancet Neurol|volume=4|issue=5|pages=281–8|year=2005|month=May|pmid=15847841|doi=10.1016/S1474-4422(05)70071-5}}</ref>	?	?	PMID 15847841: Review
<ref name="pmid16545751">{{cite journal|author=Rovaris M, Confavreux C, Furlan R, Kappos L, Comi G, Filippi M|title=Secondary progressive multiple sclerosis: current knowledge and future challenges |journal=Lancet Neurol|volume=5|issue=4|pages=343–54|year=2006|month=April|pmid=16545751|doi=10.1016/S1474-4422(06)70410-0}}</ref>	?	?	PMID 16545751: Review
<ref name="pmid17884680">{{cite journal|author=Miller DH, Leary SM|title=Primary-progressive multiple sclerosis|journal=Lancet Neurol |volume=6|issue=10|pages=903–12|year=2007|month=October|pmid=17884680|doi=10.1016/S1474-4422(07)70243-0}}</ref>	?	?	PMID 17884680: Review
<ref name="pmid15727225">{{cite journal|author=Stadelmann C, Brück W |title=Lessons from the neuropathology of atypical forms of multiple sclerosis |journal=Neurol. Sci. |issue=Suppl 4 |pages=S319–22 |volume=25 |year=2004 |month=November|pmid=15727225|doi=10.1007/s10072-004-0333-1 }}</ref>	?	?	PMID 15727225: Review
<ref>{{cite cochrane|last=Burton|first=JM|coauthors=O'Connor, PW; Hohol, M; Beyene, J|title=Oral versus intravenous steroids for treatment of relapses in multiple sclerosis.|journal=Cochrane database of systematic reviews (Online)|date=2012 Dec 12|issue=12|review=CD006921|pmid=23235634|}}</ref>	?	?	PMID 23235634: Meta-Analysis, Review
<ref name="RCOP_acute">{{cite book|first=The National Collaborating Centre for Chronic Conditions|title=Multiple sclerosis : national clinical guideline for diagnosis and management in primary and secondary care|year=2004|publisher=Royal College of Physicians|location=London|isbn=1-86016-182-0|pages=54–57|url=http://www.ncbi.nlm.nih.gov/books/NBK48919/pdf/TOC.pdf|accessdate=6 February 2013|format=pdf|pmid=21290636|}}</ref>	?	?	PMID 21290636: book guideline.--Garrondo (talk) 07:35, 9 July 2013 (UTC)
<ref name=Aubagio>{{cite press release|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm319277.htm |title=FDA approves new multiple sclerosis treatment Aubagio |publisher=US FDA|date=2012-09-12 |accessdate=2013-01-21}}</ref>	?	?	Press release
<ref name=fumarate>{{cite press release|url=http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1801165|title=Biogen Idec’s TECFIDERA™ (Dimethyl Fumarate) Approved in US as a First-Line Oral Treatment for Multiple Sclerosis|publisher=Biogen Idec |date=2013-03-27|accessdate=2013-06-04}}</ref>	?	?	Press release
<ref>{{cite journal|last=Manouchehrinia|first=A|coauthors=Constantinescu, CS|title=Cost-effectiveness of disease-modifying therapies in multiple sclerosis.|journal=Current neurology and neuroscience reports|date=2012 Oct|volume=12|issue=5|pages=592–600|pmid=22782520|}}</ref>	?	?	PMID 22782520: Review
<ref name=He2012>{{cite journal|last=He|first=D|coauthors=Xu, Z; Dong, S; Zhang, H; Zhou, H; Wang, L; Zhang, S|title=Teriflunomide for multiple sclerosis|journal=Cochrane database of systematic reviews (Online)|date=2012 Dec 12|volume=12|pages=CD009882|pmid=23235682|doi=10.1002/14651858.CD009882.pub2|editor1-last=Zhou|editor1-first=Hongyu}}</ref>	?	?	PMID 23235682: Review
<ref name=Tsang2011>{{cite journal|last=Tsang|first=BK|coauthors=Macdonell, R|title=Multiple sclerosis- diagnosis, management and prognosis.|journal=Australian family physician|date=2011 Dec|volume=40|issue=12|pages=948–55|pmid=22146321|}}</ref>	?	?	PMID 22146321: (unspecified, possibly primary) review.--Garrondo (talk) 07:35, 9 July 2013 (UTC)
<ref name=Hassan2011>{{cite journal|last=Hassan-Smith|first=G|coauthors=Douglas, MR|title=Management and prognosis of multiple sclerosis.|journal=British journal of hospital medicine (London, England : 2005)|date=2011 Nov|volume=72|issue=11|pages=M174-6|pmid=22082979|}}</ref>	?	?	PMID 22082979: Review
<ref name="pmid21205679">{{cite journal |author=Freedman MS |title=Long-term follow-up of clinical trials of multiple sclerosis therapies |journal=Neurology |volume=76 |issue=1 Suppl 1 |pages=S26–34|year=2011|month=January |pmid=21205679|doi=10.1212/WNL.0b013e318205051d |url=}}</ref>	?	?	PMID 21205679: Review
<ref name="pmid22284996">{{cite journal |author=Qizilbash N, Mendez I, Sanchez-de la Rosa R |title=Benefit-risk analysis of glatiramer acetate for relapsing-remitting and clinically isolated syndrome multiple sclerosis|journal=Clin Ther |volume=34|issue=1 |pages=159–176.e5 |year=2012 |month=January |pmid=22284996|doi=10.1016/j.clinthera.2011.12.006|url=}}</ref>	?	?	PMID 22284996: Meta-Analysis, Review
<ref name="pmid21205678">{{cite journal |author=Bates D |title=Treatment effects of immunomodulatory therapies at different stages of multiple sclerosis in short-term trials |journal=Neurology |volume=76 |issue=1 Suppl 1|pages=S14–25 |year=2011 |month=January |pmid=21205678|doi=10.1212/WNL.0b013e3182050388 |url=}}</ref>	?	?	PMID 21205678: Review
<ref name="pmid22642799">{{cite journal|author=Johnston J, So TY|title=First-line disease-modifying therapies in paediatric multiple sclerosis: a comprehensive overview|journal=Drugs |volume=72 |issue=9 |pages=1195–211 |year=2012 |month=June|pmid=22642799|doi=10.2165/11634010-000000000-00000 |url=}}</ref>	?	?	PMID 22642799: Review
<ref>{{cite journal |author=Killestein J, Rudick RA, Polman CH |title=Oral treatment for multiple sclerosis |journal=Lancet Neurol |volume=10 |issue=11 |pages=1026–34 |year=2011 |month=November |pmid=22014437|doi=10.1016/S1474-4422(11)70228-9 |url=}}</ref>	?	?	PMID 22014437: Review
<ref>{{cite book |author=Kellerman, Rick D.; Edward N. Hanley Jr MD |title=Conn's Current Therapy 2012: Expert Consult - Online and Print |publisher=Saunders |location=Philadelphia |year=2011 |pages=627 |isbn=1-4557-0738-4 |url=http://books.google.ca/books?id=pyKjGU5JdqQC&pg=PT662}}</ref>	?	?
<ref name=CochMit2013>{{cite journal|last=Martinelli Boneschi|first=F|coauthors=Vacchi, L; Rovaris, M; Capra, R; Comi, G|title=Mitoxantrone for multiple sclerosis.|journal=Cochrane database of systematic reviews (Online)|date=2013 May 31|volume=5|pages=CD002127|pmid=23728638|}}</ref>	?	?	PMID 23728638: (unspecified, possibly primary) Cochrane syst review,--Garrondo (talk) 07:35, 9 July 2013 (UTC)
<ref>{{cite journal|last=Marriott|first=JJ|coauthors=Miyasaki, JM; Gronseth, G; O'Connor, PW; Therapeutics and Technology Assessment Subcommittee of the American Academy of, Neurology|title=Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.|journal=Neurology|date=2010 May 4|volume=74|issue=18|pages=1463–70|pmid=20439849|}}</ref>	?	?	PMID 20439849: Review
<ref name=Balak2012>{{cite journal|last=Balak|first=DM|coauthors=Hengstman, GJ; Çakmak, A; Thio, HB|title=Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review.|journal=Multiple sclerosis (Houndmills, Basingstoke, England)|date=2012 Dec|volume=18|issue=12|pages=1705–17|pmid=22371220|}}</ref>	?	?	PMID 22371220: Review
<ref name="pmid17131933">{{cite journal |author=Sládková T, Kostolanský F |title=The role of cytokines in the immune response to influenza A virus infection |journal=Acta Virol. |volume=50 |issue=3 |pages=151–62 |year=2006 |pmid=17131933| }}</ref>	?	?	PMID 17131933: Review
<ref name="pmid14974077">{{cite journal |author=Munari L, Lovati R, Boiko A |editor1-last=Munari |editor1-first=Luca M. |title=Therapy with glatiramer acetate for multiple sclerosis |journal=Cochrane database of systematic reviews (Online) |issue=1 |pages=CD004678 |year=2004 |pmid=14974077|doi=10.1002/14651858.CD004678}}</ref>	?	?	PMID 14974077: Review
<ref name="pmid15592724">{{cite journal |author=Tremlett H, Oger J |title=Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis |journal=J. Neurol. |volume=251 |issue=11 |pages=1297–303 |year=2004 |month=November |pmid=15592724|doi=10.1007/s00415-004-0619-5 }}</ref>	?	?	PMID 15592724: Review
<ref name="pmid19882365">{{cite journal |author=Comi G |title=Treatment of multiple sclerosis: role of natalizumab |journal=Neurol. Sci. |volume=Suppl 2 |issue= S2|pages=S155–8 |series=30|year=2009 |month=October |pmid=19882365|doi=10.1007/s10072-009-0147-2 }}</ref>	?	?	PMID 19882365: Review
<ref>{{cite journal|last=Hunt|first=D|coauthors=Giovannoni, G|title=Natalizumab-associated progressive multifocal leucoencephalopathy: a practical approach to risk profiling and monitoring.|journal=Practical neurology|date=2012 Feb|volume=12|issue=1|pages=25–35|pmid=22258169|}}</ref>	?	?	PMID 22258169: Review
<ref name="pmid22014437">{{cite journal |author=Killestein J, Rudick RA, Polman CH |title=Oral treatment for multiple sclerosis |journal=Lancet Neurol |volume=10 |issue=11 |pages=1026–34 |year=2011 |month=November |pmid=22014437|doi=10.1016/S1474-4422(11)70228-9 |url=}}</ref>	?	?	PMID 22014437: Review
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<ref name="a1">{{cite journal|last=van Zuuren|first=EJ|coauthors=Fedorowicz, Z; Pucci, E; Jagannath, VA; Robak, EW|title=Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis patients.|journal=Cochrane database of systematic reviews (Online)|date=2012 Dec 12|volume=12|pages=CD009903|pmid=23235683|}}</ref>	?	?	PMID 23235683: Review

--Garrondo (talk) 07:35, 9 July 2013 (UTC)

Animation

Just a note that the 1887 blinking animation of a male nude taking a couple of steps is extremely annoying and makes it very difficult to read the stuff written beside it. It is unhelpful and adds nothing.Gaiatechnician (talk) 04:19, 17 July 2013 (UTC)

If I may, I'd like to support the previous comment. I find the animated illustration very distracting, annoying, and adding nothing to the value of the otherwise very detailed and informative piece. I also fail to see if it closely relates to MS symptoms in general. If it stays, could you at least move it to a less critical section? I coordinate translation efforts of key medical/health care articles into 80+ language wikies, and in certain target countries this illustration may be found offensive. With Doc.James's permission, I would like to leave it out of the source text when this article is sent to our translation teams. Ildiko Santana (talk) 00:20, 18 July 2013 (UTC)

Yes we can leave it out of the translation. Languages can add it independently after the fact.Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:32, 18 July 2013 (UTC)

Regarding translation: do as you see fit. Regarding how it relates to MS symptoms: IT IS AN ANIMATION OF A PATIENT WITH MS WALKING WITH A CRUTCH DUE TO HIS DISEASE, AND HAS MARKED WALKING PROBLEMS TYPICAL OF THE DISEASE: You can like it or not, found it offenssive or not... but saying it is not related to MS symptoms is probably a subconscious approach to the "I do not like it". --Garrondo (talk) 07:22, 18 July 2013 (UTC)

Agree and it is on the subpage. I have removed the copy here. By the way can one set animations such that they must be clicked on before they start? I think that would be nice and less distracting. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:21, 17 July 2013 (UTC)

I completely disagree: it is an animation from 3 different perspectives of a walking patient with walking difficulties so it certainly adds medical and encyclopedic value to the article. As I said before: unless there is a better image (and even better: a video) it is a good depiction of how patients walk. Moreover, since it is probably the first historical video of a patient moving at the very least I would leave it at the history section. People finding it annoying due to being an animation or to the patient being nude is what is not a valid reason for elimination. --Garrondo (talk) 08:07, 17 July 2013 (UTC)

Can we set the animation such that it must be clicked on? I do not care that it is a nude. Many people do not like short clips the cycle rapidly. IMO it does not add enough to justify its existence within the main article. It is on the subpage already. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:12, 17 July 2013 (UTC)

I supposse it can be done, although not sure on how to do it, and I do not have the time to do it for the next 2 weeks (on holiday). As a compromise in the mean time, move it to the history section and we can continue discussion when I am back. --Garrondo (talk) 07:22, 18 July 2013 (UTC)

No hurry, we can continue to discuss when you get back. Looks like we would have to convert it to a movie file and than it will not loop endlessly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:25, 18 July 2013 (UTC)

It should definitely be removed; nudity is unnecessarily offensive on pages that are not exclusively related to anatomy, and shouldn't be on the article's main page. I don't believe anyone would want their children, who may be curious about an illness to see something like that. — Preceding unsigned comment added by 97.77.49.102 (talk) 20:19, 10 February 2014 (UTC)

I was shocked by the images of naked patients and I don't think they belong anywhere on the main page or on this talk page. They are historically relevant in that they show an unthinking disrespect for patients. Would the patient have consented to the outrage of having these published? Is this your grandmother? Images of clothed people with M.S. showing their unique walk are not hard to find on YouTube. I have read thousands of pages about M.S. without ever seeing these images, which I think provides further evidence that they are completely beyond the pale. I hope that the people who have the authority to delete these images will do so, quickly. Please.Doyle doyle (talk) 03:01, 2 May 2014 (UTC)

See wp:NOSEE. LeadSongDog come howl! 05:29, 2 May 2014 (UTC)

you might want to check that page yourself. read paragraph 3 section (b), apply thinking process. you might also want to read the wikipedia manual of style about offensive images. Doyle doyle (talk) 05:57, 2 May 2014 (UTC)

What page are you refering to? There is no "paragraph 3 section (b) in WP:NOSEE, nor in the article. MOS is not about content, it is about presentation, and in any case it is only a guideline. The policy which pertains is wp:NOTCENSORED. You can choose whether you personally wish to see content, but not whether it belongs to the rest of the world. In various guises, this discussion has been done to death, but the conclusion is always the same.LeadSongDog come howl! 16:56, 2 May 2014 (UTC)

I saw something like this: "This page is more suitable for you if: (a) you still want to visit Wikipedia (rather than creating a fork or simply staying away) and (b) you find an image offensive but, apart from your perception of its offensiveness, have nothing more to add, within the premises of Wikipedia policies, to the discussions pertaining to replacement or removal of images by building consensus." Your defense of the status quo comes with no reasoned argument; rather than address the issues I raise, you only assert that I am not allowed to raise them.Doyle doyle (talk) 17:54, 2 May 2014 (UTC)

Ah, so it was para (b) within the lede of WP:NOSEE to which you referred. Now that that is cleared up, please understand the distinction between wp:Policy, which is binding, versus guidelines, how-to's, help pages, and essays, which are not. Unless there is a reason based in policy, we do not override other policy. I don't see in your posts above a policy basis with any potential to override wp:NOTCENSORED. Am I missing something? LeadSongDog come howl! 19:49, 2 May 2014 (UTC)

If there are better images we would definitely consider them. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:08, 2 May 2014 (UTC)

Now we are talking, thank you. I find no animations in any pluckable venue, but I do find several fine examples on YouTube. I could ask one or more of the YouTubers to put their video of themselves into the public domain. Am I on the right track? Before doing that could we get a consensus on which ones to ask?Doyle doyle (talk) 15:15, 3 May 2014 (UTC)

Signs and symptoms %

"The condition begins in 85% of cases as a clinically isolated syndrome over a number of days with 45% having motor or sensory problems, 20% having optic neuritis, and 10% having symptoms related to brainstem dysfunction, while the remaining 20% have more than one of the previous difficulties." - There seems to be a problem but I'm not sure how to fix it... 45+20+10=75 +20 = 95. Shouldn't these add up to 100? (I think mentioning 85 at the beginning makes it more confusing, though I'm not good with numbers ;) ) Ildiko Santana (talk) 02:42, 26 July 2013 (UTC)

Thanks yes fixed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:40, 26 July 2013 (UTC)

Evolutionary Perspective

Education Program:Case Western Reserve University/ANTH 302 Darwinian Medicine (Fall 2013)

There is no section that addresses how a disease like Multiple Sclerosis has come to be so widespread. Evolutionary Medicine is a growing field and can offer good insights into this disease.

The complexity of Multiple Sclerosis makes it difficult to pin point the proximate causes for the disease, but the ultimate cause that has been suggested is relatively simple. The relationship between vitamin D deficiency and severity of MS symptoms is well documented. An appreciable difference in symptoms between males and females can be explained by differences in vitamin D metabolism; women evidently metabolize D more quickly and are therefore more susceptible to MS (Slavov, 2013).

Vitamin D deficiency itself is caused by a mismatch between the amount of UVB exposure in a populations’ ancestral environment and their current environment. Near the equator not only is there a greater amount of exposure, but it is more consistent throughout the year. In more northern latitudes there is reported to be a 250% difference between seasons in the amount of UVB exposure possible to humans. The difference in UVB exposure is used to explain the evolution of lighter skin pigmentation, which has now been linked to an individual’s risk for MS. Lighter skin pigment does not interfere with the absorption of UVB light as much as darker skin, allowing for the synthesis of more vitamin D. Vitamin D is then used to regulate the immune system. The exact link between Vitamin D’s role in the immune system and MS is still murky, but the relationship between D and MS has been well documented.

A mismatched evolutionary and modern environment is not the only cause of the increased occurrence of MS. Cultural and social changes also play a role in that humans came first to rely on agriculture for their food, eliminating other Vitamin D rich food sources from their diet. This, compounded much later by industry demanding long hours working indoors away from UVB exposure is part of the most recent theory to explain the ultimate cause of the modern populations susceptibility to MS (Jablonski, 2013). Raj58 (talk) 18:02, 1 December 2013 (UTC)

Raj58, Are you proposing adding the text above? Please provide PubMed identifiers (PMIDs) for your sources. SandyGeorgia (Talk) 18:09, 1 December 2013 (UTC)

I presume "Slavov" is PMID 24191393 and "Jablonski" is probably PMID 24112698. That being the case, I worry that any content discussing the direct evolutionary impact on multiple sclerosis is going to be WP:SYNTH - an attempt by yourself to make sources fit a particular theory that has itself not received a lot of coverage in the medical literature.

This is a featured article, which means that any attempted addition should ideally be of the same quality as one would expect from other featured content. I would very much suggest that edits are discussed here first (verbatim). JFW | T@lk 15:37, 2 December 2013 (UTC)

I have added a short reference to Goodin's cascade model and vitamin D as playing a causal role in MS. I have used both journal references and an MS news site (MS Discovery Forum) for reference. As I may contribute to this page again in the future, if you don't like what I've done, please let me know why. Thanks. Eperotao (talk) 21:33, 5 April 2014 (UTC)

Please use secondary sources. These include review articles. We do not typically use primary sources and news sites as they are of questionable notability / reliability. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:40, 6 April 2014 (UTC)

Newer drug treatments

Newer drug treatments have been studied more recently. Tecfidera for example, as previously mentioned, has been shown to have promising effects. Katelyn0902 (talk) 22:46, 25 February 2014 (UTC)

Dimethyl fumarate is investigational, and we cannot make predictions about whether it will be used widely. It could be covered in "Research directions" but only with the support of high-quality secondary sources. JFW | T@lk 10:02, 26 February 2014 (UTC)

Table

Hi people, as this article is featured I felt I should run it by you's before I create a collapsed table I have planned. The table will compare the various disease-modifying treatments with regard to adverse effects, approximate cost per month according to drugbank, the strength of evidence to support their use, their mechanism of action and their purported efficacy. I plan to collapse it so as to not overwhelm the laymen. Fuse809 (talk) 03:11, 10 March 2014 (UTC)

Collapsible tables are not recommended per the MOS as there are accessibility issues. Additionally that sort of detail should go here Management_of_multiple_sclerosis if anywhere. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:50, 10 March 2014 (UTC)

If this is to be similar to the list on chemotherapy I'd be a little bit reluctant. This is an overview article, and original research should be avoided. JFW | T@lk 15:12, 10 March 2014 (UTC)

I'm not even talking about original research, I plan to use review articles to back up my claims like I do with all my tables. Fuse809 (talk) 21:18, 10 March 2014 (UTC)

Semi-protected edit request on 20 March 2014

I believe this sentence should be removed:

Although, in general, effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.[48]

I went through the cited source and could not find anything that supported this statement. The document referenced is 196 pages and is well cited. If this statement is true, the primary source should be cited.

Rdbickel (talk) 20:36, 20 March 2014 (UTC)

Rdbickel (talk) 20:36, 20 March 2014 (UTC)

We do not generally cite primary sources. Info is on page 55. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:22, 20 March 2014 (UTC)

Not done: deactivating template per JMH Cannolis (talk) 23:46, 20 March 2014 (UTC)

Semi-protected edit request on 24 March 2014

Please change: "Although there is no known cure for multiple sclerosis, several therapies have proven helpful. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects. Alternative treatments are pursued by some people, despite the shortage of supporting evidence."

to: "Although there is no known cure for multiple sclerosis, several therapies have proven helpful. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. Typical treatments include physical therapy and pharmacological therapy. Medications used in the management of MS have several adverse effects. Alternative treatments are pursued by some people, despite the shortage of supporting evidence."

because physical therapy is considered a common intervention to improve, maintain or reduce loss of function for patients with Multiple Sclerosis. This is not an alternative medication because significant studies have been completed on physical therapy such as those seen in the citation included above. Bwhit030 (talk) 02:30, 24 March 2014 (UTC)

References

PT falls in under "several therapies have proven helpful" No one states PT is alt med. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:10, 24 March 2014 (UTC)

Statins

A comment on an article in New Scientist [9] may be worth including if anyone knows where and how to put it in the article (I only have lay knowledge of the subject). Tony Holkham (talk) 10:32, 5 April 2014 (UTC)

We would need a better source first. This appears to be very preliminary and is popular press. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:24, 5 April 2014 (UTC)

Understood, tho' the article does refer to The Lancet article (abstract - [10]). It's also alluded to in Nature. Leave it to you. Cheers Tony Holkham (talk) 21:04, 5 April 2014 (UTC)

Per WP:MEDRS we typically use secondary rather than primary sources for medical content. This study was small. Was not a phase 3 trial. Did not look at a hard end point. We should wait until it is incorporated into a secondary source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:12, 5 April 2014 (UTC)

Thanks again. I suspected I was a little out of my depth on this one. Tony Holkham (talk) 21:18, 5 April 2014 (UTC)

Etimology

There is no etimology section. Why is it called sclerosis? — Preceding unsigned comment added by 200.125.116.114 (talk) 21:04, 11 April 2014 (UTC)

It's there at the end of the lede. Sclerosis because the brain and spinal cord have many sclerae (plaques or lesions), multiple because there are many sclerae. MidlandLinda (talk) 19:48, 22 April 2014 (UTC)

Peripheral nervous system involvement

There is growing evidence that the peripheral nervous system is involved. see http://www.ncbi.nlm.nih.gov/pubmed/20629712 and also http://www.ncbi.nlm.nih.gov/pubmed/15383952. I can't find a secondary source, although I will keep looking. I'm wondering if these studies warrant changing the one sentence from: The peripheral nervous system is rarely involved. to: Impact on the peripheral nervous system is under investigation.Doyle doyle (talk) 14:46, 3 May 2014 (UTC)

causes, tighten it up

I propose deleting this sentence: Theories try to combine the data into likely explanations, but none has proved definitive. (a) theories are not the sort of things that try (b) the idea in the sentence is already contained in the paragraph Doyle doyle (talk) 15:52, 3 May 2014 (UTC)

Not sure what your concern is? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:57, 3 May 2014 (UTC)

Imagine that sentence gone, leaving this: The cause of MS is unknown; however, it is believed to occur as a result of some combination of environmental factors such as infectious agents and genetics.[1] While there are a number of environmental risk factors and although some are partly modifiable, further research is needed to determine whether their elimination can prevent MS.[18]Doyle doyle (talk) 16:34, 3 May 2014 (UTC)

Semi-protected edit request on 9 July 2014

14.98.153.129 (talk) 12:12, 9 July 2014 (UTC)

Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. NiciVampireHeart 12:27, 9 July 2014 (UTC)

Pathogenesis

Lancet Neurology review - doi:10.1016/S1474-4422(14)70101-2 JFW | T@lk 12:17, 20 July 2014 (UTC)

Life Expectancy

Under the introduction and under the prognosis section it appears that a relatively recent edit is along the lines of life expectancy. Specifically, the claim is made that life expectancy is 5-10 years lower for individuals suffering from this disorder than those without.

This is problematic for a few reasons. (1) the claim relies on one source, where that source's entire contents are not public and the portion that is does not back up any of the cited claims; (2) the prognosis claim directly refutes information available at other reputable sources (e.g., http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001747/ , http://www.nationalmssociety.org/What-is-MS/MS-FAQ-s#question-Is-MS-fatal , and http://www.sciencedaily.com/releases/2014/01/140121104245.htm which acknowledges one study found a decrease in average life expectancy but acknowledges the lack of knowledge on how 1990s+ medicine has affected the prognosis); and (3) given that this page serves as a first-line resource for individuals newly suffering from this disorder it is a claim that requires significant proof to justify the mental anguish it will cause in newly diagnosed patients.

Given that (a) the claim is inflammatory; (b) it contradicts other, professionally researched resources and (c) the source supporting this claim does not do so from the public perspective, I propose the life expectancy claim, as well as any other claim relying on source [1] which does not find itself specifically addressed in the abstract, be removed immediately.

At the very least, all references to that source which are not borne out by the abstract need to be marked with "citation needed," "disputed," or something equivalent. The human stakes are simply too high for such a bold and apparently unsupported claim to go uncorrected.

The Lancet is an excellent source. How does 5 to 10 years less not agree with "6 years less"? [11] This is a poor source [12]

So the answer is no we will not remove the source. Go to your local medical library and pick up a copy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:11, 23 July 2014 (UTC)

The point is not to insinuate that The Lancet botched the study; the point is to say that the important nuance of the study is lost in the assertion that, if you have MS, you can expect to live 5-10 years less. Judging from the study I referenced, that was not their finding -- it was far more nuanced and conditional, it mixed relapsing remitting with primary progressive, and it studied a population with far less exposure to modern interferon-and-beyond medicine. For all of these reasons, the claim that "If you have MS, then you will live 5-10 years less than you would otherwise" is not logically and consistently true. Not to the level of confidence implied by the article.

Okay added "on average". Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:42, 23 July 2014 (UTC)

Thank you. I'd add this small change if I could, but it still is locked -- I'd change the sentence from "Life expectancy is on average 5 to 10 years lower than that of an unaffected population" to "Across the primary progressive and relapsing remitting subtypes, life expectancy is on average 5 to 10 years lower than that of an unaffected population". This is important as relatively few suffer from PP (~15%) while those unfortunate enough to do so suffer significantly shorter life expectancies; those suffering from RR see significantly shorter impact to their life expectancies (to the point of questionable statistical significance).

The 5 to 10 years is for the disease overall. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:03, 23 July 2014 (UTC)

Semi-protected edit request on 2 August 2014

Have not read reference #1 so cannot comment on accuracy of reference but still question the statement under Prognosis "The average life expectancy is 30 years from the start of the disease, which is 5 to 10 years less than that of unaffected people.[1]". As there is a typical 20 year window of onset (ages 30 to 50) the quoted statement does not correlate. The statement should read one (i.e "The average life expectancy is 30 years from the start of the disease") or the other (i.e. "The average life expectancy is 5 to 10 years less than that of unaffected people") but not both. 150.101.20.44 (talk) 01:07, 2 August 2014 (UTC)

Ref says both. We at Wikipedia do not determine the "truth" we just report the conclusions of reliable sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:20, 2 August 2014 (UTC)

Sales numbers

I would like to show the following section at the end of the article. Reason: Multiple Sclerosis has — like all other diseases — also a big economical effect and I think it is very interesting to see the money the pharma companies are making with this disease. So I think it is reasonable to show the the economical impact in an overview article. Please comment if you agree / disagree with showing the section in the article.

Sales

List of the top 10 best-selling multiple sclerosis drugs of 2013:

No.	2013 Global Sales	INN	Trade names	Companies
1	$4.33 billion	Glatiramer acetate	Copaxone	Teva
2	$3.00 billion	Interferon beta 1a	Avonex	Biogen Idec
3	$2.51 billion	Interferon beta 1a	Rebif	Merck KGaA
4	$1.93 billion	Fingolimod	Gilenya	Novartis
5	$1.41 billion	Natalizumab	Tysabri	Biogen Idec
6	$1.38 billion	Interferon beta 1b	Betaseron/Betaferon	Bayer HealthCare
7	$876 million	Dimethyl fumarate	Tecfidera	Biogen Idec
8	$303 million	4-Aminopyridine	Ampyra	Acorda Therapeutics
9	$250 million	Adrenocorticotropic hormone	H.P. Acthar Gel	Questcor Pharmaceuticals
10	$221 million	Teriflunomide	Aubagio	Sanofi

--LamasUI (talk) 05:55, 22 September 2014 (UTC)

References

Not here but IMO okay on the subpage Management of multiple sclerosis Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:28, 22 September 2014 (UTC)

I agree that it is too "niche" to discuss on this page. The subpage on management sounds better. JFW | T@lk 20:35, 22 September 2014 (UTC)