Talk:Multiple sclerosis

NEJM

doi:10.1056/NEJMra1401483 JFW | T@lk 15:53, 11 January 2018 (UTC)

Macdonald criteria revised also: doi:10.1016/S1474-4422(17)30470-2 JFW | T@lk 13:19, 21 January 2018 (UTC)

Outdated Sources and Factual Discrepancies

Although the article on multiple sclerosis is eloquent and generally informative, many of its attributions are rather obsolete and possibly misleading (or even erroneous). For instance, the sentence in the prognosis section - "Almost 40% of people with MS reach the seventh decade of life" - is derived from an article published in May 1987, yet there have been significant advances in longevity since then, so it is likely that this claim is, in fact, false. (In fact, the 2019 Merck Manual article claims that "Life span is shortened only in very severe cases" [cf. https://www.merckmanuals.com/professional/neurologic-disorders/demyelinating-disorders/multiple-sclerosis-ms].) In addition, the article does not consider the possible efficacy of acetyl-L-carnitine, which may potentially have some benefit in mitigating fatigue among MS patients with low levels of L-carnitine (cf. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/acetyl-l-carnitine/faq-20057801). Finally, the article discounts the clinical efficacy of oral cannabinoid extracts, even though another Mayo Clinic article suggests that certain medical cannabinoid extracts may alleviate spasticity and pain among some MS patients (cf. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/cannabis-for-ms-can-it-help-treat-symptoms/faq-20112500). Because the article exerts significant influence as a gold-star recipient, it would be great if it could be updated to reflect recent advances in MS treatment and diagnosis.

2600:1700:F5A1:2460:2103:FE62:D17A:4EA7 (talk) 18:00, 21 July 2020 (UTC)

Vaccinations show no association is without citation

Under Other: "Vaccinations were studied as causal factors; however, most studies show no association." This statement is without citation and misleading. The citations used do not support this statement. There is a snippet in the citation used that suspects Hepatitis B vaccination may cause MS but finds no correlation. This alone does not support the complete statement that "most studies show no association to all vaccinations"

Furthermore: "some shots may trigger an infection that causes you to relapse. If you get a live vaccine (which contains tiny, weakened amounts of a live virus), this is more likely to happen." citation: https://www.webmd.com/multiple-sclerosis/multiple-sclerosis-and-vaccines

"Multiple sclerosis presenting as late functional deterioration after poliomyelitis." citation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397915/

"Certain striking similarities to the epidemiological patterns found in paralytic poliomyelitis have been noted" and "Multiple sclerosis has been shown to be rare between the equator and latitudes 30-35 degrees...In poliomyelitis a similar variation with latitud occurs" citation: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0404.1966.tb02007.x

These statements contraindicate the misleading statement from the main article and postulate a link of MS and Poliomyelitis (or Post-polio syndrome). Considering the polio vaccine is a live attenuated virus that leads to vaccine derived polio outbreaks. — Preceding unsigned comment added by 2605:A601:A0C6:1200:EDC2:D071:347A:4EFE (talk) 08:05, 14 October 2021 (UTC)

In conclusion: "virus bad unless injected into you for profit to prevent you from contracting the virus..then virus good. Hurr durr derp da derp. derp da derp a doo." — Preceding unsigned comment added by 2605:A601:A0C6:1200:EDC2:D071:347A:4EFE (talk) 08:10, 14 October 2021 (UTC)

needs update on disease processes

Both the top para and later sections of this article assume inflammatory activity is the core of MS.

However this is now being questioned. See e.g. Smouldering multiple sclerosis: the ‘real MS’. Gavin Giovannoni, Veronica Popescu, Jens Wuerfel, ... First Published January 25, 2022 Review Article Find in PubMed https://doi.org/10.1177/17562864211066751 — Preceding unsigned comment added by JCJC777 (talk • contribs) 05:59, May 22, 2022 (UTC)

Treatments

The treatments section is a complete mess. Do we want to include exact clinical trial data in the article (e.g. X was reduced the annual relapse rate by n% compared to Y) or we want to stick with the moderate, mild, ... terminology? Now there are numerical data for some treatments but not for all.

The issue is that there is not head-to-head trials for all pairs of drugs. I propose including the numerical data of the pivotal clinical trials that have led to FDA/EMA/... approvals + the year of the approval.

The idea of putting all these things in a table might also work but I don't want to spend two hours building the table and someone removing it just because it is hard to maintain. So I think we should not go with the table idea now. BehMon (talk) 22:09, 7 July 2022 (UTC)

I d say if the table can be found in a strong Med-RS, it would be very hard for someone to remove. If you make up a table combining data from various sources, it would prob be taken away shortly. Cinadon36 22:23, 7 July 2022 (UTC)

See WP:NOT; Wikipedia is an encyclopedia, not a journal, not a textbook, etc. Word summaries digestible to a layperson are more encyclopedic and enduring ... no, we don't want numerical data and overly technical content. Summarizing reviews in plain language and encyclopedic tone can be hard to do, but that's how it's best done. SandyGeorgia (Talk) 23:56, 7 July 2022 (UTC)

We should resist, I think, the temptation to compare available therapies with each other, especially based on individual trial data of each molecule. Meta-analysis is not something one can or should do in a Wikipedia article, while a simple "comparison table" will be likely misleading (as it won't reflect baseline differences or confounding factors) and I will be the first one to remove it. — kashmīrī ^TALK 00:15, 8 July 2022 (UTC)

I agree that such a table can be misleading and people may be temped to compare across trials. BehMon (talk) 18:12, 8 July 2022 (UTC)

There is another way to go: I can surely find a very strong MED-RS classifying treatments as "highly effective" and "moderately effective" and so on.

The current situation is that the article has numerical data for some treatments and has no data for others. This is also a bit misleading. BehMon (talk) 18:18, 8 July 2022 (UTC)

Let me dig a bit deeper for good MED-RS on this matter. BehMon (talk) 18:20, 8 July 2022 (UTC)

I did a bit of search in the literature. The following paper seems to be a very good MED-RS for treatments:

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joim.13215

In particular, I was thinking about adding a table similar to Table 1 of this paper. BehMon (talk) 18:39, 8 July 2022 (UTC)

I hope you will begin to use the Diberri tool or a {{PMID}} template when referring to sources, for example, either:

• PMID 33258193 or
• Piehl F (June 2021). "Current and emerging disease-modulatory therapies and treatment targets for multiple sclerosis". J Intern Med. 289 (6): 771–791. doi:10.1111/joim.13215. PMC 8246813. PMID 33258193.

Repeating, Wikipedia is an encyclopedia, not a textbook or journal. There are (at least) two problems with building a table similar to that in the source:

1. How would you avoid copyvio? The open access license of that article is not compatible with Wikipedia's licensing.
2. How would any of that very technical jargon be useful to a layreader?

Summarizing journal literature in encyclopedic form is an art that has to be learned when editing Wikipedia; a summary in English is more useful than a table. (I'd also be curious to know if a recent source with authorship beyond one country, Sweden, exists.) SandyGeorgia (Talk) 18:51, 8 July 2022 (UTC)

There are almost 4,000 recent MEDRS sources available in Pubmed, including several thousand that are freely available, and 500 freely available published within the last year, so there are plenty of sources, and using the best of those would be ideal. Is the consensus group in PMID 34422112 highly regarded? Is there a broader consensus group guideline or position statement available? SandyGeorgia (Talk) 19:06, 8 July 2022 (UTC)

Re. copyright, such tables (listing of clinical trial outcomes for registered MS drugs) usually don't include enough original authorship to enjoy copyright protection – much like a telephone directory cannot be copyrighted. See also here: [1]. Hope this helps. — kashmīrī ^TALK 19:54, 8 July 2022 (UTC)

Assuming we are talking about replicating some version of this table from this source, let's get a second opinion from the expert: @Diannaa:. I'm often messed up on copyvio (although I would still find such a table unhelpful in the article). SandyGeorgia (Talk) 20:10, 8 July 2022 (UTC)

Hi Sandy, the paper is released under a Creative Commons Attribution-NonCommercial-NoDerivs License, which is not a compatible license. I suggest making a list of the various available treatments, removing all the supplementary info such as dosage information, route of administration, etc. Regardless of the copyright issue, that level of detail is beyond the scope of what Wikipedia is (i.e. Wikipedia is not a how-to guide), so we should not be including it anyways. I recommend making the list alphabetical within each type of drug. — Diannaa (talk) 23:40, 8 July 2022 (UTC)

Thanks, Diannaa! That was my thinking as well ... SandyGeorgia (Talk) 00:06, 9 July 2022 (UTC)

PS, although I don't think this level of detail belongs in this article at all, which uses Summary style. Detail goes to Management of multiple sclerosis, with this article being a broad overview of the key points. SandyGeorgia (Talk) 00:08, 9 July 2022 (UTC)

Agreed, if there's a sub-article that's a better location for this data. — Diannaa (talk) 00:13, 9 July 2022 (UTC)

I've moved a chunk of excess detail, per WP:SS to Talk:Management of multiple sclerosis, for incorporation there if not already included. A bot will come through in a bit to repair the missing citations here.[2] Those edits were sample only; more could be done, remembering to take care with the important attribution requirements of WP:CWW. BehMon, perhaps you'd be interested in working on that sub-article, as treatment seems to be of interest to you ? SandyGeorgia (Talk) 00:29, 9 July 2022 (UTC)

Thanks. Sure I will work on that. BehMon (talk) 17:58, 10 July 2022 (UTC)

Great. BehMon, if you copy any of that text in to Management of multiple sclerosis, be sure you are aware of WP:CWW, and add in edit summary the words, with a link ... content copied from multiple sclerosis ... to provide attribution back to this article, where it came from. I suspect you may not need to copy it, as it can probably be entirely re-written to better and newer sources. SandyGeorgia (Talk) 18:05, 10 July 2022 (UTC)

Clarification needed

Tristario please don't remove maintenance tags without resolving the problem. Readers are confronted with the following text:

Studies show that only 16% of people with relapsing MS needed a cane to walk after 20 years.[medical citation needed][87] For people with relapsing MS, approximately 50% who do not receive disease-modifying treatments will develop secondary progressive MS after 20 years, however newer treatment options may mean this rate will be significantly lower.[155] A more recent 2016 study found only 11.3% transitioned to secondary progressive MS during the ten-year follow-up period.[156][155][87]

This is gibberish; none of the timelines are explained, and then we suddenly get a "more recent". "More recent" than which part of the paragraph, which talks about what and when? Newer treatment options" relative to when? More recent than what ? I understand it's a 2021 review talking about 2016 data; that still doesn't clear up what this paragraph is trying to say about what based on when. That is, if we have something outdated in the article, we should remove it, along with the "more recent" qualifier. SandyGeorgia (Talk) 02:33, 27 July 2022 (UTC)

Sorry, I removed the clarification tag because I thought you were just confused by the fact that the review was dated to 2021. I wasn't the one that originally added this content, I've been trying to add secondary sources, and then match what's in the secondary sources. I'll try to see if I can make it more clear. Tristario (talk) 02:38, 27 July 2022 (UTC)

Yes, I understood that ... :) THe problem is the pre-existing text is a mess, which was why I added the tag. Thanks for working on it, SandyGeorgia (Talk) 02:45, 27 July 2022 (UTC)

PS, I wouldn't trust any of what was there before :) A complete rewrite would work rather than trying to retrofit. SandyGeorgia (Talk) 02:46, 27 July 2022 (UTC)

I've now made an edit, which I hope makes it clearer. I agree that a rewrite is probably needed, especially since the other sources in the section are so old Tristario (talk) 05:20, 27 July 2022 (UTC)

Tristario yes, much better. I think you'll find throughout this article that starting over is often better than trying to rewrite what's there. See my changes; if you dislike anything, or it changes meaning, feel free to revert. The one thing it would be nice to have-- if the sources provide it-- is:

• The availability of treatments that modify the course of MS (since when ... what year or decade more or less?) has improved prognosis;

eg... the availability of treatments that modify the course of MS beginning in the 1980s ... or some such ... (I haven't look at sources, don't know when that change occurred) ... SandyGeorgia (Talk) 17:04, 27 July 2022 (UTC)

Thanks for the suggestion Tristario (talk) 01:29, 28 July 2022 (UTC)

PS, the article is in such bad shape that all I've tried to do is prevent it from getting worse since it lost status as a featured article ... a top-to-bottom rewrite is needed. SandyGeorgia (Talk) 17:06, 27 July 2022 (UTC)

I've made an attempt at rewriting the prognosis section, using newer sources. This probably isn't the final version, and some more information (eg. on life expectancy) needs to be added. Any adjustments or comments etc. are welcome --Tristario (talk) 03:34, 12 August 2022 (UTC)

Good start! SandyGeorgia (Talk) 04:37, 12 August 2022 (UTC)

I guessed that this is what you meant, but there's not citation on that sentence, and two on the next sentence. If you could cite that sentence, I'll read the source to figure out the intent of the sentence. SandyGeorgia (Talk) 12:31, 12 August 2022 (UTC)

Both of those sources mention it, but it's mainly based on the lancet source. I added that one Tristario (talk) 13:03, 12 August 2022 (UTC)

Human endogenous retrovirus

Regarding these edits,[3][4] I have removed this excess detail twice and explained why on the OP's talk. Anna Zelenska please respond to my concerns on your user talk page, and engage on this talk page to gain consensus for adding content. SandyGeorgia (Talk) 13:51, 26 June 2023 (UTC)

Reliable source?

https://tidsskriftet.no/en/2015/05/impact-environment-multiple-sclerosis I have never heard of this journal and so don't know if it's a quality journal. May or may not contain relevant information to the article. P.S. if my citation format breaks some local citation format consensus, let me know and I'll fix it. I used the default reference format so far. Chamaemelum (talk) 05:45, 13 July 2023 (UTC)

I have pointed you to WP:MEDRS on other articles; did you read WP:MEDDATE? No, you did not follow the established WP:CITEVAR (vancouver), which I also pointed you to at Talk:Alzheimer's disease; again, you can generate a fully formatted citation by plugging a PubMed ID in to this template (after verifying at PubMed that the article is listed as a secondary review.

In these edits, you introduced one WP:MEDDATE-compliant source (2022) interspersed with several very dated sources and some non-MEDRS sources. Since you didn't format the citations fully or correctly, one has to click on each citation to discover that you have used sources from 1997, 2009, 2010, and 2014, at least, when there are multiple recent reviews on genetics.

This, for example, is neither a correctly written citation nor does it meet MEDRS:

• International Multiple Sclerosis Genetics Consortium. Electronic address: chris.cotsapas@yale.edu; International Multiple Sclerosis Genetics Consortium (2018-11-29). "Low-Frequency and Rare-Coding Variation Contributes to Multiple Sclerosis Risk". Cell. 175 (6): 1679–1687.e7. doi:10.1016/j.cell.2018.09.049. ISSN 1097-4172. PMC 6269166. PMID 30343897.

What all of this means is that another editor has to re-check everything you've done and probably rewrite the whole thing to newer reviews. I suggest a full revert. SandyGeorgia (Talk) 10:20, 13 July 2023 (UTC)

I've deleted the primary source and the associated text which talks about rare variants, and tagged the other primary sources I saw in the section. Is the template generally the citation format across most medical or disease-related articles? If so, I can just use that instead of the default. I've also fixed all of the citations to match the correct style. I've deleted the dated source I added. Some of the added citations aren't within 5 years, but are the best information I could find to add to the section which consists of largely 2000s sources.

Also, I've included a primary source describing the heritability of MS, as it concurs with the secondary source I added, but is more recent and higher N. I can delete it if needed. Hopefully, the edits are now overall beneficial and don't need to be reverted (though feel free). Let me know if there's any further changes I can make, or if I can help with other parts of the article like finding newer reviews. Chamaemelum (talk) 11:06, 13 July 2023 (UTC)

Peer review an article

The article is really large and full of information, but it is missing a lot of references. Also, if there is a reference in the paragraphs, it is old and needs to be updated, such as the " Epidemiology" paragraph. Also, there are many phrases or words that refer to other Wikipedia's pages, and this makes it difficult to read the article in addition to Difficult terminology, but on the positive side, the article is really full of information and requires Edits that do not take much time. However, I didn't find much editing! Mesan Hijazy (talk) 16:15, 24 September 2023 (UTC)

Wiki Education assignment: WikiMed UTSW

This article was the subject of a Wiki Education Foundation-supported course assignment, between 21 November 2023 and 15 December 2023. Further details are available on the course page. Student editor(s): The-GOAT-of-GOATs (article contribs).

— Assignment last updated by The-GOAT-of-GOATs (talk) 18:58, 21 November 2023 (UTC)

Hello everyone, its a pleasure to be working with you all on this article. I've read through the talk page and have a general idea of what I want to start editing, but wanted to get some input on what you all think are the most important areas that need improvement and if anyone is currently working on a section of the article so that I can focus my time effectively and avoid stepping on anyone's toes. I will be adding my workplan for the next couple weeks based on your feedback soon.

Also, I'm a new wikipedian so any tips/tricks are appreciated, thanks!The-GOAT-of-GOATs (talk) 18:45, 27 November 2023 (UTC)

Workplan

• Throughout article, update citations with more up-to-date references
• Intro paragraphs: Finish by 12/3
  • change degenerative to autoimmune disease (change link as well) in first sentence for more specificity
  • Add in brief description of progressive MS in first paragraph since it describes relapsing-remitting MS
  • In second paragraph, edit sentence on proposed causes to refer to later section
  • In third paragraph, edit sentence on treatment to reflect acute flare management, disease-modifying therapy for long-term relapse prevention, and patient-centered symptom management.
  • In third paragraph, remove sentence on alternative treatments altogether since they have not been proven to be efficacious: can touch on them later in treatment section
• Signs & Symptoms section: Finish by 12/3
  • Clarify first paragraph's description of classic MS presenting symptoms
  • Clarify psychiatric symptoms of MS
  • Remove sentence on CIS: unsupported claim
  • Start third paragraph with percentages o most common symptoms using updated citation
  • Edit section on disease course to refer to MS types later in article
• Causes section: Finish by 12/3
  • Intro paragraph/sentence: clarify that leading hypothesis is autoimmune dysregulation
  • Add in section detailing autoimmunity of MS
  • Infectious agents subsection: remove first sentence as it is not helpful, rest of this subsection looks good
  • Genetics subsection: edit first paragraph's last section to reflect what ethnic groups are disproportionally impacted, edit second paragraph to clarify that only the HLA-DR15 allele is associated with higher risk of MS development
  • Geography: include role of vitamin D & latitude in explanation of increasing MS risk as you move away from the equator
  • Other: include the following risk factors: obesity, diet & gut microbiome, comorbidities
• Pathophysiology section: Finish by 12/10
  • Remove sentence on cholesterol crystals: while may be true & supported by research, is not particularly relevant to the pathophysiology of MS as we currently understand it
  • Add "immune dysregulation" subsection to explain current thoughts of the development of autoimmunity that leads to MS
• Diagnosis section: Finish by 12/10
  • Overall accurate & concise, will add in paragraph clarifying what the McDonald Criteria are, what DIS & DIT are and what can be done to prove them
  • Remove sentence on brain atrophy: this finding is non-specific to MS
  • Add paragraph on studies that can support diagnosis of MS
  • Differential Diagnosis section is overall accurate & concise
• Types & Variants: Finish by 12/10
  • Overall accurate & concise, will add paragraph detailing radiologically isolated syndrome (RIS)
• Management: Finish by 12/15
  • Acute flare management: overall accurate, clarify that IVIG & plasmapheresis can be use concurrently with steroids
  • Clarify indications & side effects of most commonly used disease-modifying drugs

Peer Review UTSW (12/10)

Good job with very detailed workplan

Good job addressing all of the edits on your work plan , I didn't find anything unaddressed

The article some left over medical jargon throughout, although good job on linking out some of the jargon to other wikipedia pages for more information that may not be relevant to this article topic

May be helpful to have a section on comorbidities as MS has quite a few, this could go under associated symptoms.

Under diagnosis section, it would be helpful to delineate diagnostic criteria that are standard of care

Did a great job fixing links/citations and some of the medical jargon is linked to another wiki article which is helpful if a reader needs clarification

Some of the signs and symptoms are under the management section instead of the symptoms section, would move these over

 — Preceding unsigned comment added by Yalayli (talk • contribs) 03:18, 11 December 2023 (UTC) 

~~~ The-GOAT-of-GOATs (talk) 15:24, 1 December 2023 (UTC)

Annualized Relapse Rate Sources (ARR)

I will be adding these sources for the ARR figures provided. Don't have the time just yet to do all the referencing but plan to do so in the next couple days! If someone feels like adding them already, thanks :)

Annualized relapse rates: -------------------------------------------------------------

Avonex 0.25 https://investors.biogen.com/news-releases/news-release-details/first-ten-year-follow-shows-treatment-avonexr-leads-long-term#:~:text=91%20percent%20of%20patients%20had,one%20relapse%20every%20four%20years

Interferons 0.256 in every 2-week group, 0.288 in every 4-week https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326221/

Copaxone 0.3 ARR https://pubmed.ncbi.nlm.nih.gov/32329362/

Aubagio 0.35 ARR https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437319/

Plegridy 0.12 ARR https://pubmed.ncbi.nlm.nih.gov/35158459/

Tecfidera 0.15 ARR https://pubmed.ncbi.nlm.nih.gov/34465252/

Vumerity 0.11-0.15 ARR https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870078/

Gilenya 0.22 - 0.25 ARR https://pubmed.ncbi.nlm.nih.gov/30731303/

Zeposia 0.18 - 0.24 ARR https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768354/

Kesimpta 0.09 - 0.14 ARR https://www.ncbi.nlm.nih.gov/books/NBK572489/table/cl4.tab11/ https://multiplesclerosisnewstoday.com/news-posts/relapsing-ms-patients-better-after-switch-kesimpta/

Mavenclad 0.1 - 0.14 ARR https://www.sciencedirect.com/science/article/pii/S221103482200270X https://www.ncbi.nlm.nih.gov/books/NBK539998/

Lemtrada 0.08 ARR (RRMS) https://pubmed.ncbi.nlm.nih.gov/31762387/

Ocrevus 0.09 ARR https://multiplesclerosisnewstoday.com/news-posts/2021/08/25/ocrevus-reduces-ms-relapse-risk-but-linked-more-hospitalizations/#:~:text=In%20terms%20of%20efficacy%2C%20Ocrevus,clinical%20trials%2C%20the%20researchers%20said. Bob (talk) 09:34, 5 December 2023 (UTC)

No confirmation of MS being autoimmune

The term "autoimmune" is vastly overused to describe diseases with no known cause. True autoimmune diseases require the presence of autoantibodies. As per this article, it is NOT confirmed to be autoimmune. It COULD be, but labeling it as such is misleading https://link.springer.com/article/10.1007/s10787-010-0054-4 Cporosus1 (talk) 10:15, 13 December 2023 (UTC)

That is rather an old source. PMID:29478610 calls it autoimmune. Are there recent sources which specifically address this question? Bon courage (talk) 10:21, 13 December 2023 (UTC)

Yeah - they support that it is autoimmune. doi: 10.1212/CON.0000000000001136 for example calls it autoimmune in the very first sentence of its introduction. Just-a-can-of-beans (talk) 07:47, 12 February 2024 (UTC)

Wiki Education assignment: Biology I from cells to organisms

This article is currently the subject of a Wiki Education Foundation-supported course assignment, between 5 September 2024 and 5 December 2024. Further details are available on the course page. Student editor(s): DreamingPhoenix, ClaraCogitationes (article contribs).

— Assignment last updated by ClaraCogitationes (talk) 16:00, 3 October 2024 (UTC)