Talk:Multiple sclerosis/Archive 5

No mention of role of MSRV/HERV virus

There is a considerable amount of literature that mentions the MSRV virus as possibly playing a role in the progression of the disease. There are even clinical trials on possible treatment options involving the suppression of HERV-family viruses. Anyone with a medicine/virology background who can have a look at these data?

Some other links:

• http://www.ncbi.nlm.nih.gov/pubmed/23308264
• http://www.direct-ms.org/sites/default/files/MS_Retrovirus.pdf
• http://www.geneuro.com/en/technologies/rationale.php

Coldpac (talk) 17:33, 13 December 2014 (UTC)

No mention of LDN which is used by some patients as one of alternative therapies

I believe it should be mentioned if we mention acupuncture and other.

See links:

• http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Low-Dose-Naltrexone
• http://www.mssociety.org.uk/ms-news-and-research/ms-research/potential-treatments/emerging-areas-of-research/ldn

Anonymous, 9:55, 11 January 2015 (UTC)

Inclusion of role of the microbiome in MS?

Before making any substantial additions to the article, I wanted to see if others who are familiar with this topic believe it would be wise to add in material (supported by WP:MEDRS reviews of course) discussing the idea that the disturbances/alterations in the micro biome may be influential in the autoimmunity underlying MS. I saw a few reviews about it on PubMed and am in the process of looking over one (I crashed into a paywall when I attempted to read the other), but I would like to hear a few other opinions if anyone cares to comment. Thanks! TylerDurden8823 (talk) 08:01, 12 October 2014 (UTC)

Bueller? TylerDurden8823 (talk) 05:29, 15 October 2014 (UTC)

Okay then, I haven't heard any objections so I'll add this material in the near future. TylerDurden8823 (talk) 00:18, 7 November 2014 (UTC)

It seems that a section about the microbiome never has been added. There is currently growing research about the influence of the Microbiome. Below an initial draft with some references. I do not have permissions to change this article, so I will not add it:

There is some evidence that the microbiome has an effect on the disease. There exist both gut microbes that seem to prevent autoimmune reactions and microbes that seem to promote them. For persons with MS the latter kind seems to be more frequent that the first.. Due to these results it has been speculated that both the diet and Antibiotics could have an effect on the disease.

References

Gydoen (talk) 17:03, 10 January 2016 (UTC)

Here's another reference that summarizes the current research regarding the gut microbiome and MS: Emerging Concepts on the Gut Microbiome and Multiple Sclerosis. Glenn Justin D. and Mowry Ellen M.. Journal of Interferon & Cytokine Research. May 2016, 36(6): 347-357. doi:10.1089/jir.2015.0177. Gydoen (talk) 15:03, 17 September 2016 (UTC)

Suicide?

You may have to excuse me because I am relatively new to the editing side of wikipedia and do not understand most of the formalities behind what is or is not done to articles. However, I am concerned by the presence of a suicide statistic for MS in this article. A. I do not understand how knowing this factoid is helpful for anyone who might be visiting this page, besides perhaps as a qualifier for the life expectancy value; and B. my intuition is that any sort of mention of suicide subconsciously increases the likelihood that someone will actually commit suicide, particularly when a correlation is stated between suicide and some condition that the reader may find sympathetic. All I'm saying is: why include it? what value does it bring to the reader? if none, I suggest it is dangerous, if only trivially. Is there a precedent or policy related to this sort of thing? Again, I'm new here. Any help/information/response is appreciated.

94% of medical students read Wikipedia. This will hopefully remind them to ask people with MS about suicidal thoughts so that they can than arrange the help they may need thus reducing the risk of suicide. Doc James (talk · contribs · email) 06:33, 20 November 2014 (UTC)

Also, the notion that mention of suicide increases the risk of suicide has been examined before and been found to be false. I agree with James' comment that medical professionals and students alike will benefit from such knowledge as might friends and family of individuals who suffer from multiple sclerosis since it may help them to understand the depth of MS sufferers' burden more completely. TylerDurden8823 (talk) 07:59, 20 November 2014 (UTC)

Proposed merge with Vision problems in multiple sclerosis

Excessive focus on one set of symptoms. No independent evidence that this aspect is notable as a stand-alone topic or specific to this disease (vs other similar neurological disorders). Is written as a stand-alone essay (mostly focusing on defining the terms, but we already have articles on each symptom), so there's little that's actually about relationship with MS. DMacks (talk) 16:18, 11 December 2014 (UTC)

• Nothing to merge, no good sources. Redirect to Multiple sclerosis Multiple sclerosis signs and symptoms. DMacks, since MS is a Featured article, would you mind removing the tag from the top of the article and placing it instead on the talk page? It's unfortunate that an FA is tagged/defaced because of this one essay. SandyGeorgia (Talk) 16:21, 11 December 2014 (UTC)

 Done. DMacks (talk) 16:25, 11 December 2014 (UTC)

Should be merged here Multiple sclerosis signs and symptoms if anywere. Doc James (talk · contribs · email) 04:53, 12 December 2014 (UTC)

• Redirect, no content that needs merging. I am going to be BOLD and remove that box, as per SandyGeorgia JFW | T@lk 09:36, 17 December 2014 (UTC)

 Done Nobody objected to merge+redirect and multiple others said there was nothing specific to merge and agreed with a specific target, so I just redirected it. Anyone interested in trying to fish out some details to put into some other article is welcome to look at the history. DMacks (talk) 06:35, 5 January 2015 (UTC)

Improvements to Use of language

I can spot several places in the text where improvements could be made to the form of expression used:

1)1st paragraph; 'myelin' should be mentioned in relation to 'insulating sheath'. This would explain the use of 'myelin' in the 2nd para.

2) Para 3: 'lack of evidence' of what ?. Should read 'lack of evidence of their effectiveness'.

4) Signs & Symptoms: '..difficulties thinking..' should read '...difficulties with thinking...'

5) '... previous difficulties..' should be '..previously mentioned difficulties...', or better still '.. these difficulties...'.

6) Causes: what does it mean to 'modify' an environmental factor ? 'Avoidable' is probably what is intended.

7). Geography. 'home country' is ambiguous in the context. 'Native' is probably intended (i.e. country of birth). — Preceding unsigned comment added by 77.96.60.31 (talk) 10:50, 4 January 2015 (UTC)

Hi, thanks for your valuable remarks, these are all non-controversial changes, feel free to fix the things yourself :) Regards, kashmiri ^TALK 00:01, 5 January 2015 (UTC)

Preactive lesions

It seems stablished that the earlier stage of a MS lesion is a cluster of activated microglia in a NAWM area. There is a review from 2009 summarizing these findings [1].(van der Valk P, Amor S. Preactive lesions in multiple sclerosis. Curr Opin Neurol. 2009 Jun;22(3):207-13. doi: 10.1097/WCO.0b013e32832b4c76. PMID 19417567)

As far as I know this description of the lesion starting process has not been disputed during the last four years. Could it be included into the lesion evolution section?:--Juansempere (talk) 11:16, 6 January 2015 (UTC)

Chlamydia pneumoniae as an Infectious Agent

I would like to propose that Chlamydia pneumoniae be added as a proposed infectious agent. The following references are studies which have found a significantly higher incidence of C. pneumoniae in M.S. patients.

Sriram, S., Stratton, C. W., Yao, S.-Y., Tharp, A., Ding, L., Bannan, J. D., & Mitchell, W. M. (July 01, 1999). Chlamydia pneumoniae infection of the central nervous system in multiple sclerosis. Annals of Neurology, 46, 1, 6-14.

Munger, K. L., Peeling, R. W., Hernán, M. A., Chasan-Taber, L., Olek, M. J., Hankinson, S. E., Hunter, D., ... Ascherio, A. (March 01, 2003). Infection with Chlamydia pneumoniae and Risk of Multiple Sclerosis. Epidemiology, 14, 2, 141-147.

Any high quality review articles from the last 5 years? Doc James (talk · contribs · email) 21:55, 12 February 2015 (UTC)

Demyelinating diseases

Demyelinatiation may cause lot's of problems in the patient own body. However, mylination can happen under certain circumstances. Read more here:

http://medicalxpress.com/news/2015-03-myelinate-nerve.html

MansourJE (talk) 18:00 27 March 2015 (UTC)

MansourJE (talk) 04:52, 21 April 2015 (UTC)

Catalyzing body's own immune cells system

One of the purposes of the current multiple sclerosis's drugs is to alleviate the pains that is in the muscles. However, recent research desires to catalyze body's own immune cell lost to be replaced.

Read more:

http://medicalxpress.com/news/2015-04-drugs-body-stem-cells-brain.html

MansourJE (talk) 09:17 21 April 2015 (UTC)

I don't think you have necessarily understood the nature of MS or what the article is proposing. JFW | T@lk 22:57, 21 April 2015 (UTC)

Semi-protected edit request on 7 May 2015

Changing:

There are several historical accounts of people who lived before or shortly after the disease was described by Charcot and probably had MS.

to:

There are several historical accounts of people who probably had MS and lived before or shortly after the disease was described by Charcot.

might improve clarity. Nolanamy (talk) 20:39, 7 May 2015 (UTC)

Done Stickee (talk) 02:01, 8 May 2015 (UTC)

30 years

"been known for over thirty years" refers to a period of over 30 years ending 2012. So it may be better and safe to say "since the 1980s", which will be less confusing in years to come. JMK (talk) 12:02, 19 August 2015 (UTC)

Agree User:JMK excellent suggestion. Doc James (talk · contribs · email) 15:23, 19 August 2015 (UTC)

Cost of Medical Dimethyl Fumarate vs. chemical

I am aware that the wholesale cost of Tecfidera (anti-Multiple Sclerosis drug; only ingredient is dimethyl fumarate, apparently) is $109 per 240 milligram capsule. An ordinary dose is one capsule per day, and thus a cost of about $40,000 per year. https://www.biogen.com/content/dam/corporate/en_us/pdfs/vermont-pricing-disclosure/3.18.2015.long-form-tecfidera.pdf Yet, Sigma-Aldrich sells dimethyl fumarate at $64 per 100 grams http://www.sigmaaldrich.com/catalog/search?term=Dimethyl+fumarate&interface=Product%20Name&N=0+&mode=mode%20matchpartialmax&lang=en&region=US&focus=productN=0%20220003048%20219853286%20219853269 , equivalent to over 400, 240 milligram capsules. (and Sigma-Aldrich isn't exactly known as a low-cost supplier, either!) In other words, a cost of about 16 U.S. cents per capsule, making Tecfidera about 700x more expensive. I'm very new to editing WP; but I think it would be desireable to include these facts in the dimethyl fumarate (and Multiple Sclerosis) articles. I understand that ideally, this would involve the use of secondary sources, but in some situations the use of primary sources (including those I've listed above) might be appropriate as well. Could somebody who is interested in this help me out here? Sluefoot (talk) 18:35, 7 September 2015 (UTC)

You would need a medical source which says this is possible / recommended. We do sometimes include info like this such that we often use the iv solution of vancomycin rather than the pills because the iv solution is cheaper. Doc James (talk · contribs · email) 21:08, 7 September 2015 (UTC)

Semi-protected edit request on 23 November 2015

please add information about HSCT for MS - it has been in clinical trials for MS for the last 15 years in USA and 12 years in Canada. http://themscure.blogspot.ca/2010/06/stem-cell-transplantation-reference.html https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation it is readily available - worldwide - but only if you pay for it or if you fit into the narrow NCT clinical trials. http://www.hsctstopsms.com/hsct-facilities-worldwide/ It is the same procedure as the procedure for cancer patients up to age 65 since the 1960's - chemotherapy followed by stem cell transplant. The stem cells are most commonly obtained from the patients own bone marrow. They are usually extracted by medications that drive the stem cells out of the bone marrow and into the blood stream which is then extracted and saved until after the patient completes chemo, then reinfused. Thank you. This is critical information that is not publicized much as there is no profit in this procedure as it halts MS.

2001:569:739F:4A00:C0D5:7864:C8A1:EC8D (talk) 18:24, 23 November 2015 (UTC)

Is their a review article that discuses? Please see WP:MEDRS. best Doc James (talk · contribs · email) 11:44, 24 November 2015 (UTC)

A bit dated but PMC 3448948 is à propos. LeadSongDog come howl! 14:17, 24 November 2015 (UTC)

There has been a more up to date article on this therapy published in the Journal of the American Medical Association - https://jama.jamanetwork.com/article.aspx?articleid=2091305. — Preceding unsigned comment added by 81.187.150.195 (talk) 22:12, 28 September 2016 (UTC)

Under discussion, disable template Mdann52 (talk) 17:03, 4 December 2015 (UTC)

Medical Cannabis

Here is the text of the source in question:

" 4. Summary

The beneficial therapeutic effects of cannabinoids and potentially the endocannabinoids in symptom management in MS can now be said to be proven, particularly for symptoms such as spasticity. The potential for cannabis in slowing disease progression in MS is less clear, but experimental evidence clearly suggests that cannabis and the endocannabinoids are definitely neuroprotective, and the findings of a single clinical trial performed with THC capsules, though certainly not definitive, do suggest that there was a neuroprotective benefit in a sub-group of patients with a lower initial level of disability (although the numbers in this group were too low for a definitive conclusion). Such a clinical trial needs to be repeated in a larger group of MS patients with lower levels of disability on entering the study. In ALS, the field is some years behind that of MS. Experimental studies do point to a potential role of cannabis and the endocannabinoids in the management of this disease, particularly with regard to symptoms such as pain and spasticity, but also potentially in the modification of disease progression, and the need for clinical trials in this area to investigate this is indicated."

Psyden (talk) 00:24, 27 March 2016 (UTC)

That is not about "medical cannabis", which is what you wrote. That is about nabiximols and cannador which is a specific THC extract from cannabis. I started back on Management of multiple sclerosis as you should have and am working my way here. Jytdog (talk) 00:26, 27 March 2016 (UTC)

As defined by wikipedia: "Medical cannabis, or medical marijuana, refers to the use of cannabis and its cannabinoids to treat disease or improve symptoms"Psyden (talk) 06:16, 27 March 2016 (UTC)

This source is not making general claims about "medical cannabis". It talks very specifically about two interventions in the context of MS, as I mentioned above. Additionally, Wikipedia articles are not reliable sources. I just tagged that sentence and asked on the talk page what its source is. Jytdog (talk) 08:07, 27 March 2016 (UTC)

Source added. What phrasing would you propose? Psyden (talk) 13:55, 27 March 2016 (UTC)

I am struggling with that. Like I said we have Management of multiple sclerosis which is a WP:SPLIT from this article. Per WP:SYNC the section on management in this article really should be be the lead of that article, with sources added. I am trying to get time to review that article in comparison with the section here to get that article brought up to date, and its header brought up to date, so it can be brought over here. It is not clear to me if the use of THC and Nabiximols is important enough to rise to the lead of that article and so whether it should be included in this article at all. There is a lot of work to do. Jytdog (talk) 20:51, 27 March 2016 (UTC)

New drug-free treatment/cure for multiple sclerosis: FMD (fasting mimicking diet)

The media have reported a new cure for MS (tested extensively in mice, and in a small pilot study of humans) and the authors recommend its immediate application. Can someone read the paper (Cell Report June 2016) and implement it into the Wikipedia article? The media version is as follows (The Telegraph, 1 June 2016, I have corrected the punctuation):

Scientists from the University of Southern California showed that in mice, the Fasting Mimicking Diet (FMD) significantly lowered the percentage of damaging immune cells, while allowing the protective coating to regrow.

Human MS patients, who were put on the diet to check that it was not harmful to their health, also reported improved quality of life and scored better on the Extended Disability Status Scale (EDSS) which assesses movement, tremors, speech and swallowing.

Prof Walter Longo, the study’s lead author and professor who directs the USC Longevity Institute said: “The effect on humans was improvements for both quality of life and EDSS, which is remarkable because we only did a single cycle of the FMD for humans and tested them three and six months after.

“Since the pilot human trial was small, now we are setting up a large multi-center clinical trial. However, because we have already tested this and similar diets on hundreds of patients with various diseases, I believe this can be tried now by MS patients who cannot wait.”86.154.102.141 (talk) 15:59, 1 June 2016 (UTC)

Please read WP:MEDRS. We would need a review article. Doc James (talk · contribs · email) 16:03, 1 June 2016 (UTC)

Thanks, Doc and Kashmiri. I have read the Wikipedia guideline and to me it does not sound quite so absolute. But I suggest you leave my section here for a while to await confirmatory studies/reviews etc over the next 12 months. If no confirmation is forthcoming, feel free to archive this. — Preceding unsigned comment added by 86.154.102.141 (talk) 16:29, 1 June 2016 (UTC)

Curcumin

Please add curcumin as an example of still unconfirmed (but promising) herbal remedy. I would do it but the article is locked. It can be added under subsection "Alternative treatments" in the parentheses that mention medical cannabis. Here is the source:

Xie, Lin, Xiao-Kang Li, and Shiro Takahara. "Curcumin has bright prospects for the treatment of multiple sclerosis." International immunopharmacology 11.3 (2011): 323-330. — Preceding unsigned comment added by 131.211.211.65 (talk) 15:17, 2 July 2016 (UTC)

 Not done. Medical information should come from SECONDARY sources, please read this guideline. — kashmiri ^TALK 22:29, 2 July 2016 (UTC)

I did write "as an example of still unconfirmed (but promising) herbal remedy." Since there is already a section titled "Alternative treatments" in the article and it references medical cannabis as an example, it could also mention curcumin. 62.195.45.181 (talk) 12:33, 28 July 2016 (UTC)

Compliments

I would like to compliment, the creators and contributors of this page. It is by far the most comprehensive, factual and accurate summary of MS I have ever come across in the ten years I have studied MS since my wife was diagnosed back in 2006. A big thank you to all involved! SamiAEH (talk) 11:23, 14 August 2016 (UTC)

Add anxiety as a symptom of MS (In figure)?

Regarding image: [2], does anyone have any objections if the symptom 'anxiety' is added under the central set of symptoms? I am unable to find reviews that specifically talk about MS and anxiety (apart from it being listed in combination with depression or listed in addition to all the other symptoms), but I do see a number of articles that talk about anxiety being present in MS. See:

• http://www.ncbi.nlm.nih.gov/pubmed/21621796
• http://www.ncbi.nlm.nih.gov/pubmed/19965515
• http://www.ncbi.nlm.nih.gov/pubmed/12926846
• http://www.ncbi.nlm.nih.gov/pubmed/22297872
• http://www.ncbi.nlm.nih.gov/pubmed/17294613
• http://www.ncbi.nlm.nih.gov/pubmed/18215155
• http://www.ncbi.nlm.nih.gov/pubmed/11437165
• http://www.ncbi.nlm.nih.gov/pubmed/26041798
• http://www.ncbi.nlm.nih.gov/pubmed/18755825
• http://www.ncbi.nlm.nih.gov/pubmed/22860028
• http://www.ncbi.nlm.nih.gov/pubmed/18727845
• http://www.ncbi.nlm.nih.gov/pubmed/12814180
• http://www.ncbi.nlm.nih.gov/pubmed/17263009
• http://www.ncbi.nlm.nih.gov/pubmed/22729988
• http://www.ncbi.nlm.nih.gov/pubmed/21904202
• http://msj.sagepub.com/content/19/2/217
• http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2007.02041.x/full

Ping @User:Mikael Häggström, if no one objects, would you be able to add it as a symptom in the image? Kind regards.Calaka (talk) 10:42, 15 August 2016 (UTC)

It seems pretty well founded, so I added it to the image now. Mikael Häggström (talk) 13:05, 15 August 2016 (UTC)

Thank you for the quick update.Calaka (talk) 13:47, 15 August 2016 (UTC)

Semi-protected edit request on 7 October 2016

Addition to https://en.wikipedia.org/wiki/Multiple_sclerosis#Alternative_treatments Please consider adding information on a recently published study.

Summary: The research paper (Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial) reported excellent adherence to the McDougall Diet with those following the program reducing their fat intake from 40% of calories to 15% of calories, and maintaining this reduction for a year. Body weight, total cholesterol, LDL cholesterol, and insulin levels were significantly reduced for one year compared to the control group. Fatigue is a very debilitating problem for people with MS. Those following the McDougall Diet experienced remarkable improvement in their energy levels.

Notably, 85% (22/26) of the diet group subjects were diet adherent during the 12-month study. Therefore, those who doubt the power of food in curing major diseases can no longer claim that "even though the diet improves patients' health, no one can follow it." The study subjects could and did. These findings are as good, or better, than those for adherence to medications used in treating MS.

Link to Study: http://www.msard-journal.com/article/S2211-0348(16)30100-6/pdf

Thank you for your consideration. Graphicsmith, on behalf of John A. McDougall, M.D.

Graphicsmith (talk) 23:06, 7 October 2016 (UTC)

That source fails WP:MEDRS, but thanks. Jytdog (talk) 23:10, 7 October 2016 (UTC)

No mention of increased rate of ms among gulf war veterans

http://www.va.gov/ms/documents/Wallin_MS_Cohort_Incidence_Brain_2012.pdf — Preceding unsigned comment added by 83.85.83.13 (talk) 09:07, 12 November 2016 (UTC)

A secondary source is required to support this assertion. The DOI for the article is doi:10.1093/brain/aws099 and it does not appear to have been cited by anyone. As such there may be no secondary source. JFW | T@lk 21:03, 12 November 2016 (UTC)

Semi-protected edit request on 9 April 2017

Decreased sunlight exposure resulting in decreased vitamin D production has also been put forward as an explanation.

The evidence for the effectiveness for such treatments in most cases is weak or absent.[9][95] Treatments of unproven benefit used by people with MS include dietary supplementation and regimens,[9][96][97] vitamin D,[98] relaxation techniques such as yoga,[9] herbal medicine (including medical cannabis),[9][99] hyperbaric oxygen therapy,[100] self-infection with hookworms, reflexology, acupuncture.[9][101]

References

-- Reza94983 (talk) 21:49, 9 April 2017 (UTC)

I don't know what you are asking exactly, but the new source you are suggesting is what we call a "primary source" and we don't use them in Wikipedia. Please see WP:MEDDEF which is part of WP:MEDRS, the community guideline for sourcing content about health. Jytdog (talk) 22:26, 9 April 2017 (UTC)

Life expectancy values in content body and infobox on the right don't match

In the opening summary of the body, it's listed as 5-10 years shorter life expectancy. In the infobox on the right (on desktop), it reads 2-10 years.
Which is it? I can't read the fulltext of the cited source, but I do see the same citation being used for both. Mirth123 (talk) 19:14, 21 April 2017 (UTC)

Thanks for picking that up. Typo on my part. Ref says "The median time to death is around 30 years from disease onset, representing a reduction in life expectancy of 5–10 years" Doc James (talk · contribs · email) 19:26, 21 April 2017 (UTC)

Thanks 2601:194:C303:6A20:1042:6016:40D9:E851 (talk) 06:44, 24 April 2017 (UTC)

early vs delayed treatment

I noticed a 2017 Cochrane review comparing early versus delayed treatment options. PMID 28440858

The review found: "low-quality evidence of the included studies suggests a small and uncertain benefit with early treatment compared with placebo or later treatment in reducing disability-worsening and relapses."

Are you interested in adding this citation to the article, or shall we wait until stronger evidence is found pertaining to early versus late treatment options?

Thanks, Jenny JenOttawa (talk) 01:33, 25 August 2017 (UTC)

after looking thru[3] the latter is preferable,and therefore 'wait until stronger evidence is found'...IMO--Ozzie10aaaa (talk) 09:54, 16 September 2017 (UTC)

Thanks for looking into this @Ozzie10aaaa:. How do you feel if I add in a small sentence that the "benefit is uncertain" and use this Cochrane Review citation? This way when new evidence is available and Cochrane updates their review, it will be flagged by the Cochrane Update bot and easy to add in? I also do not want to clog up this article, so I understand if it is better left out entirely! JenOttawa (talk) 12:55, 16 September 2017 (UTC)

might be best to leave out, at this point--Ozzie10aaaa (talk) 13:00, 16 September 2017 (UTC)

thanks @Ozzie10aaaa: for the quick reply and advice! JenOttawa (talk) 13:04, 16 September 2017 (UTC)

One could say their is tentative evidence for a small benefit with early treatment. Doc James (talk · contribs · email) 19:09, 23 September 2017 (UTC)

When the authors' conclusions describe that evidence as "low-quality" or "very low-quality" and further asserts that "long-term safety of early treatment is uncertain", it seems unwise to even characterize that as "tentative evidence for" in the encyclopedic voice. I would suggest instead the reverse, that "no convincing evidence was found by the authors for any significant benefit". We run into this sort of thing all the time in discussing altmed: nobody wants to outright state that the treatment is inert beyond placebo, because it would take an infinite study population to prove. LeadSongDog come howl! 18:44, 29 November 2017 (UTC)

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Created article on RIS - Mention was originally present in this article but has been removed?

I decided to be bold and create an article on RIS. I remember reading about RIS on this main article but it has since been removed. Not sure of the reasoning of it but I believe it deserves a mention. Happy for changes and expansion to the article. Kind regards.Calaka (talk) 00:40, 19 March 2018 (UTC)

Semi-protected edit request on 30 September 2018

Category:Ailments of unknown cause Hausdrache5 (talk) 16:16, 30 September 2018 (UTC)

 Done Saucy^{[talk – contribs]} 23:51, 30 September 2018 (UTC)

Metabolic state and MS progression - Ketogenic / Fasting

Under Management / Treatment Larger scale studies are currently underway, but I would suggest we keep an eye on them.

PLEASE NOTE THE DIFFERENCE BETWEEN LOW-CARB AND KETOGENIC, KETOGENIC STRICTLY LIMITS CARBOHYDRATE INTAKE TO LESS THAN 5% OF TOTAL NUTRIENT VALUE BY CALORIES WHILST SUGARS REMAIN AS CLOSE TO ZERO AS POSSIBLE

In the past, many Ketogenic treatments have been dismissed as unsuccessful simply due to the fact that the diets prescribed were not actually ketogenic in the first place

2016 - Diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899145/

2018 - The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132382/

2019 - Pilot study of a ketogenic diet in relapsing-remitting MS

https://nn.neurology.org/content/6/4/e565

2015 - The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709725/

With the nervous system being mostly fat, would a mostly fat diet have an impact? — Preceding unsigned comment added by Elijah Loko (talk • contribs) 13:24, 24 June 2019 (UTC)

Semi-protected edit request on 31 July 2020

The sentence that include this phrase

"early in life is protective, the disease is"

is a comma splice. Would you add a "and" after the comma? Thank you. 2601:5C6:8081:35C0:8C6E:4F3D:980C:7804 (talk) 02:20, 31 July 2020 (UTC)

How’s this? [4] SandyGeorgia (Talk) 02:26, 31 July 2020 (UTC)

Chronic cerebrospinal venous insufficiency

I propose to add this new source:

Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis: A Failed Concept. Vasc Specialist Int. 2015 Mar;31(1):11-4. doi: 10.5758/vsi.2015.31.1.11. Epub 2015 Mar 31. Kugler N, Patel PJ2, Lee CJ

PMID:26217638 PMC:4480289

Best regards. --BallenaBlanca (talk) 13:45, 5 January 2016 (UTC)

Removal of Progressive-Relapsing entity

Quoting from the last international panel review:

"The prior category of PRMS can be eliminated since subjects so categorized would now be classified as PP patients with disease activity".

The whole article is freely available here: [5]. Whithin the new classification, the former PRMS would now be classified as "Progressive MS, Active with progression".

--Juansempere (talk) 11:20, 24 August 2016 (UTC)

Wrong data in the map

As far as I can tell, the data in the map do not agree with the data in the WHO mortality statistics for 2012! https://en.wikipedia.org/wiki/Multiple_sclerosis#/media/File:Multiple_sclerosis_world_map-Deaths_per_million_persons-WHO2012.svg — Preceding unsigned comment added by Centrum99 (talk • contribs) 17:04, 18 March 2017 (UTC)

Section needs update

The section, "During the 2000s and 2010s, there has been approval of several oral drugs that are expected to gain in popularity and frequency of use.[111] Several more oral drugs are under investigation, including ozanimod and laquinimod. Laquinimod was announced in August 2012 and is in a third phase III trial after mixed results in the previous ones.[112] Similarly, studies aimed to improve the efficacy and ease of use of already existing therapies are occurring. This includes the use of new preparations such as the PEGylated version of interferon-β-1a, which it is hoped may be given at less frequent doses with similar effects.[113][114] Request for approval of peginterferon beta-1a is expected during 2013.[114]" needs an update as it is at least 5 years out of date ("expected during 2013"). — Preceding unsigned comment added by 157.98.101.125 (talk) 13:08, 30 March 2017 (UTC)

Clinically Isolated Syndrome (CIS) - need to mention in #Disease courses (types)

Just made several changes to get the section #Disease courses (types) up to date (2013 NMSS vs. 1996 NMSS).

We need to mention Clinically Isolated Syndrome (CIS) in this section - it's been listed as the first MS "type" by NMSS since 2013 and has about 68,500 results in Google Scholar [6]

Hope we can continue to get this article a little more up to date and useful. Cheers, Facts707 (talk) 08:03, 21 August 2017 (UTC)

Preference for FDA links in citation

Hello, While updating a Cochrane review in this article, I noticed a broken FDA link for TERIFLUNOMIDE (ref 64 in the Disease modifying treatments section).

What is the preferred FDA link for this type of article? I searched the FDA site for a replacement and found a few options. I do not have very much experience inserting FDA links into Wikipedia articles, so this is a good exercise for me :)

How do you feel about using this link: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=202992

Thanks,

Jenny JenOttawa (talk) 01:17, 25 August 2017 (UTC)

I updated this link in the article. I do not know how to "archive it", so if anyone can help finish it (and teach me) I would appreciate it! JenOttawa (talk) 00:13, 23 September 2017 (UTC)

Review is relevant? and appropriate (for someone with deeper Clinical knowledge)?

I'm working my way thorugh the MS list for the Cochrane-wikipedia project, and I'm a bit stuck on a review in terms of if and where to introduce it. The review in question: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002936/full "Intravenous immunoglobulins for multiple sclerosis" The inital review was done in 2003, and has been updated to 2009. I know thats a bit long by Wikipedia standards, but it might still be relevant depending on the clincal aspect of my question?

Googling around it seems that several monoclonal antibodies (like Natalizumab, Alemtuzumab, or Ocrelizumab) could be considered 'intravenous immunoglobulins'. The review mentions by name only Natalizumab (and only once) and the other two are more recent treatments I believe. This seems to to suggest that 'intravenous immunoglobulins' as a class is more than these marketed therapies, and the review might be relevant beyond the information I've already added for Natalizumab-specific Cochrane reviews, or network meta-analyses that evaluate reletive effectiveness of more than one therapy. Anybody got any insight as to whether I'm right about my thinking about 'intravenous immunoglobulins', and the reviews relevance? YetiHed (talk) 11:09, 11 March 2020 (UTC)

I found a section of the https://en.wikipedia.org/wiki/Multiple_sclerosis_research#Treatments page I had somehow missed that looks to confirm my thinking above. I've introduced the review as a citation regarding the interest of the medications of a class. YetiHed (talk) 10:51, 13 March 2020 (UTC)

YetiHed, featured articles must maintain a consistent citation style, and it appears that you have added dozens of Cochrane reviews with a different citation style. Please be aware when you are editing a Featured articles, and use the existing citation style. I have fixed many, but not all, of them, as there are too many to fix. SandyGeorgia (Talk) 20:14, 29 July 2020 (UTC)

SandyGeorgia, Thanks for pointing this out. I have a list of articles I have modified for this project so I can rectify this if you can be a bit more specific. I used pubmed links to generate the citations, and from the link you provide its not obvious to me where the problem lies. YetiHed (talk) 09:01, 30 July 2020 (UTC)

@YetiHed: explained on your talk. SandyGeorgia (Talk) 14:49, 30 July 2020 (UTC)

Lipid metabolism?

Saw some interesting pieces about considering MS not as primarily autoimmune, but rather as a disorder of lipid metabolism. I am in no way qualified to judge the extent to which - or even whether - these sources should be used in the article, but I'll provide them here so that those more knowledgeable can decide.

• Multiple sclerosis is not a disease of the immune system, Corthals AP, Q Rev Biol. 2011 Dec;86(4):287-321.

• Lipid Metabolism May Be a Therapeutic Target in MS (not a peer-reviewed source, but has a Suggested Reading list).

• John Dirk Nieland on Discovering Lipid Metabolism's Role in MS (piece in MD Mag, whose status as an RS I am not able to judge).

Thoughts? DS (talk) 21:04, 11 April 2020 (UTC)

FAR needed

Version reviewed

This is a 2005 Featured article that averages almost 5,000 daily pageviews, but has fallen out of standard and has not been maintained. Unless someone can take on a comprehensive rewrite and update, the article should be submittted to WP:FAR.

• A consistent citation style has not been maintained (someone chunked in dozens of Cochrane reviews using a different style).
• No one is answering queries on talk, and there are multiple significant issues raised.
• The article uses a 2001 source (McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Annals of Neurology. 50 (1): 121–7. doi:10.1002/ana.1032. PMID 11456302.), and has not updated to the sources listed above by Jfdwolff two years ago:[7]
• Most of the sources used in the article are extremely dated, giving an idea of the last time the article was (not) overhauled.
• There is information in the lead which is nowhere in the body.

SandyGeorgia (Talk) 20:24, 29 July 2020 (UTC)

PMID 31463644 could be used. SandyGeorgia (Talk) 02:30, 30 July 2020 (UTC)

Poor and dated sourcing: PMID 8780061 a 1996 survey! SandyGeorgia (Talk) 02:47, 31 July 2020 (UTC)

Additional review of latest version from September 2020:

• Epidemiology has not been updated, and is out of sync with the lead.
• The "Research" section contains 8, 10 even 15-year-old research. Research that old will have either been mentioned in secondary reviews by now, or not panned out. It has become a dumping ground, UNDUE.

SandyGeorgia (Talk) 14:27, 9 October 2020 (UTC)

• Prose also needs work: too many short paras. (t · c) buidhe 14:46, 9 October 2020 (UTC)

Remove medical citation needed statement from lead

Title says it all, that is improper and should not be there, I would remove it, but am confused on the point trying to be made by the editor who added it. The information is contained in the body, specifically in the "Signs and symptoms" section, and is properly cited. This is a featured article and editors should not be placing rogue templates on the page without justification; if the template were truly needed, then the article would similarly need to be reevaluated as it clearly would fall short of featured standards. Footlessmouse (talk) 23:25, 7 November 2020 (UTC)

Please review WP:MEDDATE and the considerable unaddressed items on this page. SandyGeorgia (Talk) 00:17, 8 November 2020 (UTC)

Is MS an autoimmune disease?

The answer is we don't know, I'm not looking to discuss the pathogenesis of MS. There is an immune response but that doesn't imply autoimmune unless we can confirm it. — Preceding unsigned comment added by 77.69.218.162 (talk) 23:26, 4 January 2021 (UTC)

Alternate Remedies update.

It seems remiss to leave out mention of the Coimbra Protocol.

It is a functioning medically supervised treatment that has been used for decades to place and hold the majority of patients in remission. The fact that it is not mainstream outside Brazil and Europe does not make it ineffective, it simply means it is not accepted yet. With a few well managed trials it could become mainstream and help a lot of those afflicted.

The page below is well worth reading in full before dismissing it as crank medicine, most new discoveries have been held in poor regard at first and remember it improves the quality of life for most of those who follow the protocol. There are a lot of peer and support groups out there that will be able to offer anecdotal support to the benefits.

General Information about Coimbra Protocol

Idyllic press (talk) 08:54, 6 April 2021 (UTC)

If you have a WP:MEDRS-compliant source (rather than a promotional page), please bring it forward. We may need to mention on this page that there is no foundation for this and it is dangerous:

• https://www.mdpi.com/2072-6643/12/3/783/htm
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218089/

SandyGeorgia (Talk) 14:13, 6 April 2021 (UTC)

@Alexbrn: I like my source. Can you say what was wrong with it?--Sharonam1 (talk) 18:17, 3 May 2021 (UTC)

It's from a crap publisher. And you're now edit-warring. Alexbrn (talk) 19:52, 3 May 2021 (UTC)

Multiple issues with section 'Signs and symptoms'

There are a lot of issues with 'Signs and symptoms,' so many I don't want to try to correct them. Here they are listed

1. cognitive is misspelled
2. run-on sentence in there
3. writing style is not concise
4. Depression is not a cognitive symptom
5. Fatigue is not cognitive
6. Lhermitte's sign is not cognitive
7. dizziness is not cognitive
8. Musculoskeletal is misspelled
9. ataxia is not a musculoskeletal symptom, primarily
10. reflexes is not a musculoskeletal symptom
11. Uhthoff's phenomenon is not a specific to sensation
12. pins and needles are listed separate from paresthesias, although that is paresthesia
13. vaguesness in writing overall

I propose rolling this back to an earlier point in time and proceeding with development of this section more carefully. I don't have enough time to dig through the revisions, but at a quick glance, Jamzze, you look to be the main driver of this section. What are your thoughts on the above?

Lukelahood (talk) 20:57, 20 July 2021 (UTC)

I agree with rolling back to an earlier version; besides the problems mentioned above, the table is not effective prose, and there are other issues with compliance with policy and guideline in recent edits. SandyGeorgia (Talk) 03:17, 21 July 2021 (UTC)

I rolled it back to version number 1033887371 by user:Alexbrn on July 16th, prior to the symptom organization by table format.Lukelahood (talk) 15:42, 24 July 2021 (UTC)

Hi all - sorry that my edits did not meet the needs of the community around this article. All I can hope is that I build from this and do better going forward. Some comments I would like to leave for anyone to build upon:

1) The signs and symptoms section is not easily identifiable (mostly due to the large number of symptoms involved in MS) as it is situated within a block of text. My initial table was to try and break this down to make it easier for readers to digest the number of signs and symptoms for MS. Potentially further sub-sub-headings could help break down the text if a table is not appreciated? The picture outlining symptoms is also lacking, especially with issues that differ across biological sex. As females are most prone to MS, it would make sense to compare how signs and symptoms differ in this way as well within this picture - including general sexual and reproductive health issues.

2) Causes section: MS has no known "cause", but rather risk factors. I think this should be renamed. "Potential causes" could be added to highlight research trying to figure out what causes MS to start (e.g. autoimmune reaction to viruses, etc.)

3) Alternative treatment: there is a lot of research into medical cannabis that I think should be added into this page that was removed in the rollback.

4) The styling convention of this page is not clear. I can see there is a lot of effort within the history record to changing citations to a style. Maybe, for the ease of other authors joining, newer member, and the existing community that the styling convention is changed to what is produced by the automatic citation tool? Or, offer a clear stlye guide within the talk page for new users to understand.

There is a lot of passion within this community and MS is an issue that impacts many people, so I hope for the best to make this a resource for anyone trying to learn more about the disease. Jamzze (talk) 20:09, 18 October 2021 (UTC)

Hi Jamzze, sorry for wiping out your work. Although what you were doing overall might have been the right direction, there were too many inconsistencies/technical/semantical errors. I know as a reader if I encounter small errors, I usually disregard the rest of the article (those who can't be entrusted with small matters cannot be entrusted with larger matters). I am by no means an authority on Wikipedia or this topic, but my responses to your thoughts:

1. I believe as Wikipedia articles progress towards good article status or featured article status, they tend to ditch lists and tables for high quality prose. In my opinion, despite the various signs and symptoms, a table would not be preferred, as high quality prose could link and categorize the symptoms in a more meaningful way than a table could, as there are pathophysiologic links beyond the body system categorization.
2. Although the cause of MS is not known, it does exist and the risk factors are the best way to hint at it currently. See Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes for current standards on section titles, which supports the section title "cause" with discussion of risk factors within it. We wouldn't want to name it "potential causes" and talk about research as this information is probably more appropriately placed in the "Research directions" at the end of the article (however, this article does discuss prevailing theories, which I think is appropriate since a large portion of the community endorses these or at least considers them, and thus the reader is likely to be interested in them). Naming it "potential causes" also is not suitable for the risk factors it contains. Although the risk factors can be seen as 'potential causes,' they can also be conditions that make the main/true cause more likely to occur, and in that sense, they are part of the cause.
3. I have no opinion on that currently. I couldn't selectively undo certain edits. Sorry for taking that out.
4. No comment about the citation style. I am new to this article.

Prodomal or early phase

Hi JCJC777, I have reverted your edits for the following reasons

• The sentence "in the year before the first clinical demyelinating event, hospitalizations and physician visits were 78% and 88% higher, respectively, for people with MS than for matched controls." is a direct copy and paste from the source you cited: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324569/. Please see WP:Copy-paste, as this is not allowed.
• Regarding the sentence "Studies continue on whether MS has a prodromal or early phase, and could possibly be diagnosed and treated much earlier." None of the succeeding citations mention that studies are continuing (although they all suggest and imply that they could happen).
• The source titled "Fatigue, sleep disorders, anaemia and pain in the multiple sclerosis prodrome" is a primary source. A secondary source is preferred. This is the only source I noticed that mentioned "anemia" as a prodromal condition.
• "Prodromal Symptoms of MultipleSclerosis in Primary Care" is also a primary study
• One of your sources are cited twice in different formats
• Also, in my opinion, listing all the citations at the end is less helpful than listing them through the paragraph after the sentences they actually apply. I had trouble following your edits and knowing which article was backing up which fact. Not sure what others would think.

I do think what you were writing about is worth mentioning. A prodromal syndrome, if well supported by literature, is good for readers to know. I hope you try again with more careful referencing.

Lukelahood (talk) 22:14, 5 November 2021 (UTC)

Epidemiology reversion

Hi RLSbiology,

Thank you for your good faith rehaul of the epidemiology section. I see that you are editing as part of a college course at the University of Wisconsin, and think that it is awesome that you are learning how to edit Wikipedia during that time. I myself just started a year or two ago, and still have a lot to learn myself. However, I felt compelled to revert your contribution for the following reasons:

• It is not appropriately cited. The entire section now only has two references, one of which is to the National MS Society website in general and not to a specific article. Websites like this tend to change frequently and do not as rigorously provide their sources as medical journal articles, which are preferred sources. The other source is the Mayo clinic article, which is also less preferred (someone correct me if I'm wrong) to journal articles from reputable journals.
• It has information not directly pertaining to epidemiology. For example:
  • "Taking into account the natural history of the disease, MS has no cure. Therefore, the clinical outcome is recovery treatment, management of symptoms, and abating the progression of the disease." This has more to do with prognosis and disease management than it does epidemiology.
  • "The age onset, severity, and symptoms vary widely in cases of MS." Variance of symptoms has more to do with disease manifestation, unless symptoms are more common with a certain population or geographic region.
• You use some imprecise language. For example:
  • "As of 2019, there have been nearly one million reported cases of MS in the United States alone." This wording implies that in the entire history of the United States, there are one million cases cumulatively. More believable would be "In 2019, there were one million cases of MS in the United States."
  • "In the most recent prevalence studies conducted" it won't take long for this statement to be no longer true. Rather, cite a time period.
  • "betterment of diagnostic skills with this disease" More believable are diagnostic 'methods,' 'guidelines,' or 'tools.' Doctors are not necessarily more skilled.
• There are grammar issues
  • Disease names should not capitalized, unless eponyms
  • Citations should not have spaces before them, in order to be consistent with the rest of the article
  • There is inconsistency with capitalization of directions, such as "Northeastern region of the U.S." and "northern region of the United States"

Lukelahood (talk) 01:10, 1 December 2021 (UTC)

Saxitoxin from Dinoflagellates is the cause of MS and MSA!!

How can you know Saxitoxin is a cause of MS and MSA?

1. Because it is well known among the best saxitoxin-researchers in my country (Sweden) since a few years back. And I was told I was going to get MS (Multiple Sclerosis) or MSA (Multiple System Atrophy) by one of them when I was saxitoxin-poisoned. I did not believe in this but 1,5 years later I was severely sick in MSA.

2. And it is well known there was an outbreak of MS on the Orkney-islands when a group of British soldiers were stationed there. And what do they have there? Yes, Dinoflagelates in the sea which makes Saxitoxin which in turn poisons mussels. Then must the soldiers have taught the islanders how to cook and eat sea-mussels, and then followed the MS-outbreak of course.

3. And because it is well known that the orthodox Jews don’t get MS. One of the forbidden foodstuff for the orthodox Jews is shellfish that includes sea-mussels which can survive very high concentrations of Saxitoxin because they have ten times thicker neural-threads than other animals and therefor can get very poisonous to humans. Because it is noncoucher food this means the jews have known this for thousends of years as well as the islanders of the Orkneyislands before they were tought to eat clams.

4. Also MS is an autoimmune disease that attacks the myelin and MSA is an autoimmune disease that attacks the oligodendrocyte-cells, which makes the myelin. It is known that autoimmune diseases can be started by toxins and since these two diseases are so closely related it is also logical they can have the same cause.

Well I also know this for several other reasons. Saxitoxin has been starting MS and MSA for billions of years and will continue to do so for billions of years in the future and this has been and will be a fact for the same time-span, and I have learned this the hard way. It was proven to me by the reality.

Torbjorn Arvidsson — Preceding unsigned comment added by 189.69.119.5 (talk) 21:13, 5 December 2021 (UTC)

Please see WP:MEDRS and WP:NOTAFORUM. Article talk pages are for discussing improvements to articles based on reliable sources; you have provided none, so your message will be either archived, or removed (and if it's removed, my response can go, too). SandyGeorgia (Talk) 21:18, 5 December 2021 (UTC)

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Sources

Lancet Neurology:

• doi:10.1016/S1474-4422(14)70267-4 - environmental factors
• doi:10.1016/S1474-4422(14)70250-9 - cognitive assessment (clinical and imaging)

May be useful for updating, particularly the top one which is a review of reviews and casts doubts on some associations for environmental causation. JFW | T@lk 12:47, 17 February 2015 (UTC)

MansourJE (talk) 12:31, 27 March 2015 (UTC)

ABN guidelines on disease-modifying treatments

UK guidance on interferons, glatiramer etc. doi:10.1136/practneurol-2015-001139 JFW | T@lk 07:59, 17 July 2015 (UTC)

peginterferon beta-1a was FDA Approved in 2014

In the Research section it is listed that peginterferon beta-1a would seek approval in 2013. Well, it did: http://www.nationalmssociety.org/About-the-Society/News/FDA-Approves-Plegridy-Pegylated-Interferon-Beta LoioshDwaggie (talk) 13:38, 24 November 2015 (UTC)

Effectiveness of immunotherapy for RRMS

doi:10.1001/jama.2015.18984 JAMA clinical evidence synopsis JFW | T@lk 08:23, 27 January 2016 (UTC)

Differential diagnosis

Why is there no section on differential diagnosis? I should think this is particularly important as there are other disease entities to consider, given the disease's murky history. 184.145.94.3 (talk) 17:57, 19 April 2017 (UTC)

Please help us write one. Find good sources and post them here. Doc James (talk · contribs · email) 22:46, 19 April 2017 (UTC)

As per NMSS [8] "Differential Diagnosis Mnemonic (VITAMINS) - V - Vascular Multiple lacunar infarcts; CADASIL; spinal arteriovenous malformation - I - Infectious..." Facts707 (talk) 08:22, 21 August 2017 (UTC)

Proposed Edit of Potentially Dangerous Dated Info

Under Management>Acute Attacks, there are dated statements about use of corticosteroids, referencing ref#63, which was dated 2004. That's before some of the infectious agents started to be (more) isolated (e.g., see the earlier cited note in the article about EBV). The reference itself mentions that some of the side effects of these steroids include a Human Herpes Virus, which EBV is one of. Generally speaking, corticosteroids clear the way for infections to proliferate. The reference itself states, on page 53:

"Side effects were reported in two of the systematic reviews and two RCTs. These included herpes simplex, herpes zoster, severe ankle oedema, fractured neck of femur, acute anxiety and severe depression;117 weight gain, oedema, gastrointestinal symptoms and psychological symptoms;119 raised blood glucose;126 infection and raised blood pressure.121"

Not enough info is included on the side effects or on the possibility that corticosteroids invite a herpes virus (more info out there on for those who look). This dated information, left unqualified, could be dangerous to a lazy practioner or a convincing patient asking for meds. — Preceding unsigned comment added by Cmd7172 (talk • contribs) 09:31, 28 December 2017 (UTC)

UNDUE content

@Jnosak, Nethtam, and Guichard132: WP:UNDUE and excessively detailed content has been added here; see WP:SS and Management of multiple sclerosis, which is more appropriate for detail on secondary management. SandyGeorgia (Talk) 20:03, 22 February 2022 (UTC)

More sources (2022) on EBV and MS

https://www.nature.com/articles/s41579-022-00770-5 https://www.sciencedirect.com/science/article/abs/pii/S0165572822001308

Time for an update to causes section I think. (t · c) buidhe 07:36, 8 October 2022 (UTC)

Thx, Buidhe! Here are the citations:

• Houen G, Trier NH, Frederiksen JL (2020). "Epstein-Barr Virus and Multiple Sclerosis". Front Immunol. 11: 587078. doi:10.3389/fimmu.2020.587078. PMC 7773893. PMID 33391262.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• Aloisi F, Cross AH (October 2022). "MINI-review of Epstein-Barr virus involvement in multiple sclerosis etiology and pathogenesis". J Neuroimmunol. 371: 577935. doi:10.1016/j.jneuroim.2022.577935. PMID 35931008.

and I'll work on this shortly. The first (Houen) is redlinked by the reliability script, so as this is a recent issue, I'll stick with Aloisi. SandyGeorgia (Talk) 19:11, 8 October 2022 (UTC)

Done, [9] SandyGeorgia (Talk) 20:11, 8 October 2022 (UTC)

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MOS:MEDLANG

The word significant is used 10 times in this article (overused), and some of the instances result in confusion over whether the word implies statistical significance, or whether alternative language (eg, considerable) might be used instead. SandyGeorgia (Talk) 14:29, 2 May 2023 (UTC)

Good point. I changed a few Tristario (talk) 00:36, 3 May 2023 (UTC)

Revisiting differential diagnosis

The current differential diagnosis section lists some relevant diseases but could use more structure. Other highly rated medical articles are more broad in their differential (see myocardial infarction). In addition, the whole paragraph currently relies on a single primary source. I'm planning on updating this section using Harrison's Internal Medicine and AAFP guidelines (and relevant sources). In addition, I think the differential section could use a "red flags" section that suggests alternate diagnoses, instead of linking single symptoms with single diseases like "multiple cranial nerves = neurosarcoidosis". Will work on keeping it all short and relevant, and am open to feedback. FortWorthMedicalStudent23 (talk) 22:02, 6 March 2023 (UTC)

Great idea @FortWorthMedicalStudent23! a455bcd9 (Antoine) (talk) 07:29, 7 March 2023 (UTC)

Famous people with MS

Do we want to list people with MS? I was surprised not to see a list in the article.

I'm linking this list: List of people with multiple sclerosisDogru144 (talk) 18:24, 24 November 2022 (UTC)

I see that it was linked in the See Also section.Dogru144 (talk) 18:26, 24 November 2022 (UTC)

Do these kind of articles comply with GNC? Cinadon36 18:49, 26 November 2022 (UTC)

I think it should meet WP:NLIST as there are article such as this and this which discuss the topic of famous people with MS Tristario (talk) 05:43, 30 November 2022 (UTC)

If by GNC you meant WP:GNG Tristario (talk) 05:51, 30 November 2022 (UTC)

Protection needed

Ajpolino this article has an IP who persists in adding information cited to an advocacy organization; would it be reasonable to change the protection here ? SandyGeorgia (Talk) 21:30, 5 July 2022 (UTC)

And non-MEDRS sources, too. SandyGeorgia (Talk) 21:32, 5 July 2022 (UTC)

I find this funny. First, I am not sure what you mean by advocacy organization. If you talking about National MS Society, I wouldn't call it an "advocacy" organization. NMSS funds research and clinical trials. Second, assume that it is an advocacy organization. Does it mean that anything reported on their site should not be used? Let me give you an example: NMSS has funded a research to calculate the prevalence of MS in the US. The result is published in a reputable Neurology journal. I can't site the paper because it is "primary". Can't I site the news article about this paper on NMSS? Such an organization is in fact a reputable resource to get these non-medical data from. Note that I am not using their site as a reference for medical data!! 2607:F470:6:4001:B43D:3C63:AE9:CDAA (talk) 18:18, 7 July 2022 (UTC)

Anyways I found a recent review article containing this data and changed the references. But as an academician, I find this general rule of not citing anything from these resources very funny. 2607:F470:6:4001:B43D:3C63:AE9:CDAA (talk) 18:20, 7 July 2022 (UTC)

Well, it is the "law of the land". While I can reason with finding it funny, if you get deeper into WP-editing, you will see how it saves us from a lot of troubles (edit wars) and helps us providing accurate info. Cinadon36 20:04, 7 July 2022 (UTC)

The editor who changed to a secondary review was BehMon. If IP2607 is BehMon, then we have edit warring. So, it does look like protection is needed on this article. SandyGeorgia (Talk) 20:10, 7 July 2022 (UTC)

Yes that IP address is indeed me. I looked up the formal definition of Edit War on Wikipedia and my actions clearly do not satisfy the conditions of an Edit War. Anyways I won’t touch the article agian. No need to worry. For now I will only propose my edits in this talk. BehMon (talk) 21:35, 7 July 2022 (UTC)

Recent edits using an advocacy org as a source

The recent edits here on 28 June, here on 5 July and here on 6 July all introduce content sourced to the MS Society, rather than the underlying secondary literature. They also introduce grammatical issues and WP:UNDUE content into the lead, rather than first working content into the article body that is later summarized to the lead, resulting in a lead that is now burdened by WP:RECENTISM. The edits also introduce text that lacks globalization, focusing on US numbers instead of worldwide. While the attempt to update the number of people with MS in the US is a good one, there are surely secondary reviews (rather than advocacy sources) for that kind of data, and hopefully such data can be updated without deteriorating the writing in the lead. I suggest reverting the lot (update: I have now repaired the lead SandyGeorgia (Talk) 17:12, 6 July 2022 (UTC)) so that the new editors can start over, using WP:MEDRS sources. SandyGeorgia (Talk) 01:23, 6 July 2022 (UTC)

Worlwide prevalence and incidence are available in this recent review; we need not use US-only data from an advocacy org-- especially not in the lead.

• Lane J, Ng HS, Poyser C, Lucas RM, Tremlett H (July 2022). "Multiple sclerosis incidence: A systematic review of change over time by geographical region". Mult Scler Relat Disord. 63: 103932. doi:10.1016/j.msard.2022.103932. PMID 35667315. SandyGeorgia (Talk) 01:54, 6 July 2022 (UTC)

I have mostly repaired the lead, removing duplicated or overly detailed content to the body of the article, replaced some non-RS, and fixed ref name errors and WP:CITEVAR breaches in this series of edits. BehMon using this PMID template filler will result in consistent citations, and save other editor time. Also, please have a look at how to use named refs, as in my edits. Thanks for switching out some of the advocacy sources to recent secondary reviews. SandyGeorgia (Talk) 16:52, 6 July 2022 (UTC)

I applaud @SandyGeorgia:. Good job. Cinadon36 19:17, 6 July 2022 (UTC)

Thanks, but the article remains a dated mess :) :) SandyGeorgia (Talk) 20:01, 6 July 2022 (UTC)

The Disease-modifying treatments section of the article is a complete mess. I think it would be better to put the data for all these disease modifying treatments in a table. I would be happy to hear any objections to this idea. BehMon (talk) 18:27, 7 July 2022 (UTC)

I'm not sure that would be helpful, as tables can be harder for summarizing different aspects, as well as harder for future editors to maintain. If you want to ''propose'' a table by posting it first here on talk, that might work. SandyGeorgia (Talk) 20:13, 7 July 2022 (UTC)

EBV as the primary cause of Multiple Sclerosis

131.152.38.194 and Discospinster, I read the article and it is pretty amazing.

Although I don't claim myself to be an expert in this area, the article seemed to be the best design short of a randomized controlled clinical trial, which would be unethical for finding out the association of EBV and MS. It is a study done with access to 10,000,000 subjects, allowing them to run a sort of pseudo randomized controlled trial. They ruled out reverse-causality and confounding factors. It is also published in Science, with funding from the NIH, done in association with the Department of Defense, and the authors are at prominent schools on the East Coast.

This is a primary source. Although Wikipedia recommends to avoid primary sources, I believe this should be balanced against use up-to-date evidence. Additionally, this can be viewed as a review article in a sense, as there is plenty of literature published on EBV for more than 10 years, which this article references. Finally, the authors clearly state "...suggest EBV as the leading cause of MS," which complies with wikipedia's recommendation to "only describe conclusions made by the source" when citing primary literature.

My suggestion is to write it as "EBV is suspected to be the primary cause of MS" and in the infobox "Likely EBV." And also bolster it with one of the many news stories about this particular article? Maybe someone else can weigh in?

Lukelahood (talk) 00:01, 15 January 2022 (UTC)

Considered your (valued) analysis, it seems foolish to reject this out-of-hand per primary source, but I have other recommendations for how to incorporate it:

1. Still primary, so move it to the Research section (perhaps with its own sub-heading) until we have secondary reviews. Considering how exciting this news is, one would think those reviews would come relatively quickly.
2. No addition yet to the infobox or the lead. Once we start breaching MEDRS, we might find ourselves on a slippery slope we can't justify elsewhere.
3. To incorporate the news stories, pick the highest quality one, and make use in the cite journal template of the lay parameters. To see how to do that, go to Menstrual cycle and look at how this sentence is cited: There are four theories on the evolutionary significance of menstruation ... that method allows use to cite the journal study, but adds on the lay press summary url. SandyGeorgia (Talk) 00:20, 15 January 2022 (UTC)

I moved it to Research, and removed the (primary source) changes to the article, copyedited, and cleaned up the citation, ending up here. But I can't find a publication in PubMed to correctly cite this to using a lay-url. SandyGeorgia (Talk) 00:39, 15 January 2022 (UTC)

I carefully reviewed the article and others citing it before adding it as a cause. It's hard not to read this as the culmination of years long research pointing at EBV as the cause. For a secondary source, take this perspective article:

1. The simple statement "Correlation doesn't equal causation" doesn't do the article justice. The study was very carefully done and took great care to avoid confounding and reverse causality.
2. This is not just any random article in a random journal. This is Science and a very well designed study as one can read in reviews from experts, like here
3. I would vote for including it as `likely EBV` in cause, but understand if you want to wait for a few weeks until there's been more expert commentary. 46.86.61.45 (talk) 00:32, 15 January 2022 (UTC)

References

^ Those look like secondary sources to me. Especially the first one, albeit published by the same journal. Lukelahood (talk) 00:39, 15 January 2022 (UTC)

Can you find a PMID ? SandyGeorgia (Talk) 00:58, 15 January 2022 (UTC)

PMID 35025606 for Epstein-Barr virus and multiple sclerosis Lukelahood (talk) 01:00, 15 January 2022 (UTC)

The other one doesn't look like something that would be in pubmed

That doesn't seem to be the same study. I'm talking about linking the primary study via cite journal, and adding a lay-url as in the example at Menstrual cycle. If there are other studies you all also want to include here, that's a different story! I read that you endorsed keeping this study in the article, in spite of it being a primary study, because of the strengths like large sample size. Best, SandyGeorgia (Talk) 01:05, 15 January 2022 (UTC)

Luklahood, this article is so dated ... ugh ... search the text for the other mention of EBV, which is cited to eons ago. SandyGeorgia (Talk) 01:08, 15 January 2022 (UTC)

2007 and 2008, yeah a long history of EBV I suppose.

Try to clear up some confusion: 1) I saw the primary article and liked it, 2) I wanted to bolster it with something like New York Times (done, thanks for the advice), 3) Then the original poster (IP address) gave that review article published by Science as well on the same day, in which they boldly call it the trigger of MS, 4) You asked for the latter pubmed address, it seemed, so I gave it to youLukelahood (talk) 01:14, 15 January 2022 (UTC)

Added the pubmed and all that.. should be good.Lukelahood (talk) 01:24, 15 January 2022 (UTC)

Great! Thx for all you do here, SandyGeorgia (Talk) 01:31, 15 January 2022 (UTC)

You too, thanks for weighing in.Lukelahood (talk) 01:33, 15 January 2022 (UTC)

Yes, issues like you describe are common in research and commonly found in Wikipedia editing, but Wikipedia has these policies and guidelines because we must follow, not lead. If we get it wrong just once, there could be consequences. If the finding is as significant as it seems, there will shortly be secondary reviews and then they can be incorporated as such. SandyGeorgia (Talk) 00:41, 15 January 2022 (UTC)

Gotchya, I hear you, better sources will come about.Lukelahood (talk) 00:45, 15 January 2022 (UTC)

I agree that this belongs in the article under "Research". It certainly paves the ground for intervention trials with vaccination. JFW | T@lk 14:42, 16 January 2022 (UTC)