Management of Multiple Sclerosis Management of Multiple Sclerosis Published by: Malaysia Health Technology Assessment Section (MaHTAS) Medical Development Division, Ministry of Health Malaysia Level 4, Block E1, Precinct 1 Federal Government Administrative Centre 62590, Putrajaya, Malaysia Copyright The copyright owner of this publication is MaHTAS. Content may be reproduced in any number of copies and in any format or medium provided that a copyright acknowledgement to MaHTAS is included (...) of the related specialty will be informed about it. A discussion will be done on the need for a revision including the scope of the revised CPG. A multidisciplinary team will be formed and the latest systematic review methodology used by MaHTAS will be employed. Management of Multiple Sclerosis TABLE OF CONTENTS No. Title Page Levels of Evidence & Formulation of Recommendation i Guidelines Development and Objectives ii Guidelines Development Group v Review Committee vi External Reviewers vii Algorithm 1

Multiple sclerosis in adults: management Multiple sclerosis in adults: management Multiple sclerosis in adults: management Clinical guideline Published: 8 October 2014 nice.org.uk/guidance/cg186 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available (...) be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Multiple sclerosis in adults: management (CG186) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 28Contents Contents Overview 4 Who is it for? 4

Comprehensive Systematic Review Summary: Disease-modifying Therapies for Adults with Multiple Sclerosis 1 Practice guideline: Disease-modifying therapies for adults with multiple sclerosis Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology Alexander Rae-Grant, MD 1 ; Gregory S. Day, MD, MSc 2 ; Ruth Ann Marrie, MD, PhD 3 ; Alejandro Rabinstein, MD 4 ; Bruce A.C. Cree, MD, PhD, MAS 5 ; Gary S. Gronseth, MD 6 ; Michael Haboubi (...) of Multiple Sclerosis Centers, Hackensack, NJ 9. Department of Neuroscience, St. Luke’s University Health Network, Bethlehem, PA 10. Department of Neurology, School of Medicine, University of Virginia, Charlottesville 11. Consortium of Multiple Sclerosis Centers, Hackensack, NJ, and Department of Neurology, School of Medicine, Wayne State University, Detroit, MI 12. Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles 13. Neurology Department, Southern

Multiple sclerosis: Scenario: Managing the major symptoms and complications of multiple sclerosis Scenario: Managing complications | Management | Multiple sclerosis | CKS | NICE Search CKS… Menu Scenario: Managing complications Multiple sclerosis: Scenario: Managing the major symptoms and complications of multiple sclerosis Last revised in October 2019 Scenario: Managing the major symptoms and complications of multiple sclerosis From age 18 years onwards. Which complications should be managed (...) in primary care? Many of the complications of multiple sclerosis will be managed by a specialist multidisciplinary team. Consider liaising with members of the multidisciplinary team when taking decisions on management. However, depending on local arrangements and local guidelines, primary care practitioners may have a role to play in the management of a number of symptoms and complications including: How should I manage fatigue in a person with multiple sclerosis? Assess the person for anxiety

Practice Guideline Recommendations Summary: Disease-modifying Therapies for Adults with Multiple Sclerosis AAN Summary of Practice Guideline for Clinicians Practice Guideline: Disease-modifying Therapies for Adults with Multiple Sclerosis AAN.com ©2018 American Academy of Neurology This is a summary of the American Academy of Neurology (AAN) publication, “Practice guideline recommendations: Disease-modifying therapies for adults with multiple sclerosis,” which was published in Neurology ® (...) online on April 23, 2018, and appears in the April 24, 2018, print issue. Please refer to the full guideline at AAN.com/guidelines for more information, including definitions of the classifications of evidence and recommendations. Starting Disease-modifying Therapy (DMT) Recommendations Starting: Recommendation 1 Rationale Receiving the diagnosis of multiple sclerosis (MS) is a stressful life event. 4,5 People receiving major diagnoses may not recall much of the information given to them at the time

Multiple sclerosis Top results for multiple sclerosis - Trip Database or use your Google+ account Turning Research Into Practice ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (...) (#1 or #2) and (#3 or #4) Loading history... Population: Intervention: Comparison: Outcome: Population: Intervention: Latest & greatest articles for multiple sclerosis The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many

Multiple sclerosis: When should I suspect that a person has multiple sclerosis? Initial presentation | Diagnosis | Multiple sclerosis | CKS | NICE Search CKS… Menu Initial presentation Multiple sclerosis: When should I suspect that a person has multiple sclerosis? Last revised in October 2019 When should I suspect that a person has multiple sclerosis? Multiple sclerosis (MS) can affect nearly any part of the central nervous system. Therefore, the presenting symptoms and signs can vary greatly (...) movement abnormalities that can cause diplopia, oscillopsia (a sensation of movement of the vision), nystagmus, and internuclear ophthalmoplegia (inability to adduct one eye and nystagmus in the abducting eye on oculomotor examination). Bulbar muscle problems resulting in dysarthria or dysphagia. Basis for recommendation The information on the possible presentations of multiple sclerosis is based on the National Institute for Health and Care Excellence (NICE) guideline Multiple sclerosis: management

Multiple sclerosis Multiple sclerosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Multiple sclerosis Last reviewed: February 2019 Last updated: February 2019 Summary Demyelinating central nervous system condition clinically defined by two episodes of neurological dysfunction (brain, spinal cord, or optic nerves) that are separated in space and time. Classically presents in white women, aged between 20 to 40 years (...) , but lends greater specificity when present with brain lesions. Treatment of the condition can be divided into three parts: treatment of the acute attack; prevention of future attacks by reducing triggers and use of disease-modifying therapies; and symptomatic treatments of neurological difficulties such as spasticity, pain, fatigue, and bladder dysfunction. Definition Multiple sclerosis (MS) is defined as an inflammatory demyelinating disease characterised by the presence of episodic neurological

Vaccine-preventable Infections and Immunization in Multiple Sclerosis 1 Practice guideline update: Vaccine-preventable infections and immunization in multiple sclerosis Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology Mauricio F. Farez, MD, MPH, 1 Jorge Correale, MD, 1,2 Melissa J. Armstrong, MD, MSc, 3 Alexander Rae-Grant, MD, 4 David Gloss, MD, 5 Diane Donley, MD, 6 Yolanda Holler-Managan, MD, 7 Norman J. Kachuck, MD, 8 (...) . Department of Pediatrics, Neurology Division, Loma Linda University Health Care, CA 13. American Academy of Neurology, Minneapolis, MN 14. US Centers for Disease Control and Prevention, Atlanta, GA 15. Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA Address correspondence and reprint requests to American Academy of Neurology: guidelines@aan.com This practice guideline was endorsed by the Multiple Sclerosis Association of America on January 11, 2019

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Multiple sclerosis (MS) is a major cause of chronic, neurological disability, with a significant long-term disability burden, often requiring comprehensive rehabilitation.To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes (...) , and to highlight current gaps in knowledge.We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework.Overall, we included 15 reviews published

Rehabilitation in multiple sclerosis Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis | Neurology Advertisement Search for this keyword Main menu User menu Search Search for this keyword The most widely read and highly cited peer-reviewed neurology journal Share November 24, 2015 ; 85 (21) Special Article Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis Report of the Guideline Development, Dissemination, and Implementation (...) Getchius Gary Gronseth Melissa J. Armstrong Pushpa Narayanaswami Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis Jodie K. Haselkorn , Christina Hughes , Alex Rae-Grant , Lily Jung Henson , Christopher T. Bever , Albert C. Lo , Theodore R. Brown , George H. Kraft , Thomas Getchius , Gary Gronseth , Melissa J. Armstrong , Pushpa Narayanaswami Neurology Nov 2015, 85 (21) 1896-1903; DOI: 10.1212/WNL.0000000000002146 Citation Manager Formats Make Comment See Comments

Cladribine for treating relapsing–remitting multiple sclerosis Cladribine for treating relapsing–remitting multiple sclerosis T echnology appraisal guidance Published: 19 December 2019 www.nice.org.uk/guidance/ta616 © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent the view of NICE, arrived at after careful consideration (...) to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Cladribine for treating relapsing–remitting multiple sclerosis (TA616) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 23Contents Contents 1 Recommendations 4 2 Information about cladribine 6 Marketing authorisation indication 6 Dosage

Complementary and alternative medicine in multiple sclerosis Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis | Neurology Advertisement Search for this keyword Main menu User menu Search Search for this keyword The most widely read and highly cited peer-reviewed neurology journal Share March 25, 2014 ; 82 (12) Special Article Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis Report of the Guideline (...) , Portland; MS Center of Excellence–East (C.B.), VA Maryland Health Care System and Department of Neurology (C.B.), University of Maryland School of Medicine, Baltimore; Multiple Sclerosis Center (J.B.), Swedish Neuroscience Institute, Seattle, WA; Multiple Sclerosis Service and Complementary and Alternative Medicine Service (A.B.), Colorado Neurological Institute, Englewood; The Jacobs Neurological Institute (B.W.-G.), Buffalo, NY; Department of Neurology (G.S.G.), University of Kansas Medical Center

Ocrelizumab for treating primary progressive multiple sclerosis Ocrelizumab for treating primary Ocrelizumab for treating primary progressiv progressive multiple sclerosis e multiple sclerosis T echnology appraisal guidance Published: 12 June 2019 www.nice.org.uk/guidance/ta585 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent (...) inequalities. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Ocrelizumab for treating primary progressive multiple sclerosis (TA585) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 21Contents Contents 1 Recommendations 4 2 Information about

Diagnosis and Treatment of Multiple Sclerosis: Guidelines Diagnosis and Treatment of Multiple Sclerosis: Guidelines | CADTH.ca Find the information you need Diagnosis and Treatment of Multiple Sclerosis: Guidelines Diagnosis and Treatment of Multiple Sclerosis: Guidelines Published on: January 3, 2018 Project Number: RA0941-000 Product Line: Research Type: Other Diagnostics Report Type: Reference List Result type: Report Question What are the evidence-based guidelines for the full spectrum (...) of care (including diagnosis and treatment) of patients with multiple sclerosis? Key Message One evidence-based guideline was identified regarding the full spectrum of care (including diagnosis and treatment) of patients with multiple sclerosis. Tags multiple sclerosis, nervous system Files Rapid Response Reference List Published : January 3, 2018 Follow us: © 2019 Canadian Agency for Drugs and Technologies in Health Get our newsletter:

Peginterferon beta-1a for treating relapsing–remitting multiple sclerosis Peginterferon beta-1a for treating relapsing–remitting multiple sclerosis T echnology appraisal guidance Published: 19 February 2020 www.nice.org.uk/guidance/ta624 © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Your responsibility Your responsibility The recommendations in this guidance represent the view of NICE, arrived at after careful (...) a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Peginterferon beta-1a for treating relapsing–remitting multiple sclerosis (TA624) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 18Contents Contents 1 Recommendations 4 2 Information about peginterferon beta-1a 5 Marketing

Ocrelizumab (Ocrevus) - multiple sclerosis 30 Churchill Place ? Canary Wharf ? London E14 5EU ? United Kingdom An agency of the European Union Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5555 Send a question via our website www.ema.europa.eu/contact © European Medicines Agency, 2018. Reproduction is authorised provided the source is acknowledged. 9 November 2017 EMA/790835/2017 Committee for Medicinal Products for Human Use (CHMP) Assessment report Ocrevus International non (...) Chain LC-MS Liquid Chromatography - Mass Spectrometry; LC-UV Liquid Chromatography - Ultraviolet; LMWS Low-Molecular-Weight Species; LPA Leached Protein A LPM Liters Per Minute;. LRV Log Reduction Value MAR Multivariate Acceptable Range MCB Master Cell Bank MMV Murine Minute Virus Mn2+ Manganese MS Multiple Sclerosis MTX methotrexate NA Not Applicable NANA N-acetylneuraminic acid;; NEM N-ethylmaleimide NF National Formulary NGHC Non-glycosylated Heavy Chain. NGNA N-glycolylneuraminic acid; non-CPP

Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial. Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS).To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue.A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single

Disease modifying drugs for treatment of primary progressive multiple sclerosis: A health technology assessment Disease modifying drugs for treatment of primary progressive multiple sclerosis: A health technology assessment - NIPH Search for: Søk Menu To top level Close Infectious diseases & Vaccines Mental & Physical health Environment & Lifestyle Health in Norway Quality & Knowledge Research & Access to data About NIPH Close Disease modifying drugs for treatment of primary progressive (...) multiple sclerosis: A health technology assessment Order Download: Key message We have systematically collected and reviewed the evidence for clinical efficacy for disease modifying treatments for PPMS. We included three randomised placebo-controlled trials that each compare the effect of one medication (either fingolimod, ocrelizumab or rituximab, respectively) with placebo. For each of the three drugs, we calculated the risk ratios for confirmed disease progression. We also report results in the form

The effect of yoga on the quality of life and fatigue in patients with multiple sclerosis: A systematic review and meta-analysis of randomized clinical trials. The impact of yoga on the quality of life and fatigue in patients with multiple sclerosis (MS) has shown various results in different reports. As a result, performing a systematic review and meta-analysis to guide physicians and patients seems necessary. The present study was carried out to evaluate the effect of yoga intervention