Does everyone need to take disease modifying drugs for MS?

Question:
​I have RRMS and my course of my MS is pretty stable. My new neurologist looked at my MRI in December 2016 and there was no sign of new activity. His opinion was to just use medication for my symptoms and no disease modifying drug (DMD) he asked my opinion but I told him i will follow his advice. I am very happy with my neurologist and trust him. I do seem to get a lot of people that have MS, via social sites, not understanding why my neurologist didn't give a DMD. Diagnosed in 2012 and no relapse since. Your thoughts?

Answer:
Excellent question. While I can not comment on your case without knowing the particulars, it is true that not everyone requires a disease modifying therapy. The threshold for starting DMTs differs between MS specialists.

I often will recommend monitoring with every 6 month MRI scans in people who have experienced one attack (as in your case) with few risk factors for disease activity and progression.

​Risk factors, usually in combination, that would make me consider starting a DMT in a case like yours would include:

1. More than 3 typical white spots on your Brain MRI  or multiple white spots on the spinal cord
2. Multiple enhancing lesions on your MRI
3. Multifocal involvement at onset
4. Limited recovery from initial attack
5. Frequent attacks in the first 2 years
6. African american or latino background
7. Males
8. Early evidence of brain atrophy

Hope this helps

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

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