Challenges in MS Management


  • The CDC does not require physicians in the US to report new cases of MS and the symptoms of the disease can go unrecognized for some time. Thus, MS statistics are only a general estimate, and prevalence is likely much higher than current estimates might suggest.1
  • The signs and symptoms of MS vary among patients and can even fluctuate in the same person. As a result, making an accurate diagnosis is challenging, and misdiagnosis is a common problem in MS care.2
  • There is no single clinical feature or diagnostic test that is sufficient to diagnose MS, and diagnosis is mainly a clinical one supported by MRI and other tests.3
  • Despite advances in the diagnosis of MS, several questions remain regarding the application and the implications of the new criteria in the daily clinical practice and in clinical trials.3,4

Disease Progression

  • Each patient’s disease progression varies, and independent of the disease course, the individual may experience various impairments due to ongoing or intermittent symptoms, limitations in activity, and restrictions in participation throughout the course of the disease.5,6


  • Available agents reduce the incidence of relapses, but do not completely eliminate them. Treatment can also reduce the frequency and severity of relapses.7
  • Coupled with the need to take additional symptomatic therapies, adherence to disease-modifying therapy can be very difficult for extended periods of time. Maintaining motivation and treatment adherence in patients with MS is an important, yet difficult undertaking.

Patient-Related Challenges

  • Patients and family members must learn how to cope with a chronic, potentially disabling disease for which there is no cure.7
  • Many patients expect their symptoms to completely resolve, and they assume (falsely) that their medication is not working when their symptoms return. Patients must be aware that there are no drugs that cure MS; perceived lack of efficacy accounts for upwards of half of all MS therapy discontinuations.7,8
  • Evaluations of interferon beta and glatiramer acetate indicate that only 60% to 76% of patients with MS adhere to therapy for 2 to 5 years.9-11
  • Some patients believe that injections are dangerous, and in their minds this is confirmed if they experience an autonomic response like flushing or palpitations upon injection. Patients often experience fear, anxiety, and avoidance when it comes to self-injection.12,13
  • Patients and clinicians continue to grapple with low levels of satisfaction with health and social care aspects of MS. Nearly all people (97%) who have started treatment say their commitment to managing their disease is their prime motivation for adhering to therapy, though people with the disease report barriers such as affordability of prescription medicine, injection-related issues and side effects, and difficulty of maintaining medication schedules.14,15


  1. Multiple Sclerosis Foundation. Learn About Multiple Sclerosis. Available at:
  2. Waubant E. Improving outcomes in multiple sclerosis through early diagnosis and effective management. Prim Care Companion CNS Disord. 2012;14(5)
  3. Milo R, Miller A. Revised diagnostic criteria of multiple sclerosis. Autoimmun Rev. April – May 2014;13(4-5):518-524.
  4. 4: Brownlee W, et al. Diagnosis of multiple sclerosis: progress and challenges. Lancet. 2017;389(10076):1336-1346.
  5. Definition of Terms – Beta-2 draft. Paper presented at: World Health Organization1999; Geneva.
  6. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Available at:
  7. Costello K, Kennedy P, Scanzillo J. Recognizing nonadherence in patients with multiple sclerosis and maintaining treatment adherence in the long term. Medscape J Med. 2008;10(9):225.
  8. Tremlett HL, Oger J. Interrupted therapy: stopping and switching of the beta-interferons prescribed for MS. Neurology. Aug 26 2003;61(4):551-554.
  9. Haas J, Firzlaff M. Twenty-four-month comparison of immunomodulatory treatments – a retrospective open label study in 308 RRMS patients treated with beta interferons or glatiramer acetate (Copaxone). Eur J Neurol. Jun 2005;12(6):425-431.
  10. O’Rourke KE, Hutchinson M. Stopping beta-interferon therapy in multiple sclerosis: an analysis of stopping patterns. Mult Scler. Feb 2005;11(1):46-50.
  11. Ruggieri RM, Settipani N, Viviano L, et al. Long-term interferon-beta treatment for multiple sclerosis. Neurol Sci. Dec 2003;24(5):361-364.
  12. Cox D, Stone J. Managing self-injection difficulties in patients with relapsing-remitting multiple sclerosis. J Neurosci Nurs. Jun 2006;38(3):167-171.
  13. Mohr DC, Boudewyn AC, Likosky W, Levine E, Goodkin DE. Injectable medication for the treatment of multiple sclerosis: the influence of self-efficacy expectations and injection anxiety on adherence and ability to self-inject. Ann Behav Med. Spring 2001;23(2):125-132.
  14. Medical News Today. Significant Barriers Prevent People With MS From Fully Committing To Treatment Regimen, New Survey Reveals. Available at:
  15. Barriers to Treatment Commitment Survey. Available at: