Fast Five Quiz: Managing Progression of Relapsing-Remitting Multiple Sclerosis

Christopher Luzzio, MD; Kerstin Hellwig, MD


July 01, 2022

Figure 1. This color-enhanced, T2-weighted, sagittal FLAIR MRI of a patient with long-standing MS shows multiple hyperintense lesions (yellow) in the periventricular white matter, which is characteristic of demyelinating lesions of MS.

Preliminary data suggest that patients with high circulating levels of vitamin D are at lower risk for MS. Therefore, vitamin D supplementation may reduce the risk of developing MS and of conversion from a first clinical event to definite MS. Although supplementation with vitamin D has been a focus of clinical trials for the treatment of MS, these trials have come to mixed conclusions.

DMTs do not seem to be effective in targeting symptomology of MS and are not prescribed for symptom improvement. Immunomodulating drugs approved for RRMS reduce clinical relapses, suppress MRI activity, and to various degrees, slow the rate of disability progression.

Depression and anxiety are treated in much the same way in patients with MS as in patients without MS. SSRIs are the preferred medication class for treating depressive symptoms in patients with MS. Second-line treatment options include tricyclic antidepressants. However, patients should be monitored for drug-drug interactions and advised on managing multiple medications.

Many patients with MS are deficient in vitamin D; however, supplementation may be beneficial for other health reasons. For healthy individuals, serum vitamin D concentrations of 20-50 ng/mL (50-125 nmol/L) are generally considered adequate for bone and overall health, while serum vitamin D concentrations of 30-40 ng/mL (75-100 nmol/L) have been proposed as optimal for patients with MS. Serum levels and liver enzymes should be monitored while supplementing, particularly with high doses of vitamin D.

Pharmacologic therapy as used in Alzheimer's dementia has not yet been proven to be beneficial for cognitive impairment in MS.

Specialists generally advise against patients with MS receiving live attenuated virus vaccines while receiving immunosuppressive therapy.

Learn more about deterrence and prevention of MS.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.