Multiple sclerosis is a former featured article. Please see the links under Article milestones below for its original nomination page (for older articles, check the nomination archive) and why it was removed. | ||||||||||||||||
This article appeared on Wikipedia's Main Page as Today's featured article on November 18, 2005. | ||||||||||||||||
| ||||||||||||||||
Current status: Former featured article |
This article is of interest to multiple WikiProjects. | ||||||||||||||||||||||||||||||||||||||||||||||
|
This article was the subject of a Wiki Education Foundation-supported course assignment, between 2 September 2021 and 14 December 2021. Further details are available on the course page. Student editor(s): RLSbiology (article contribs). Peer reviewers: Marltaly9990. This article was the subject of a Wiki Education Foundation-supported course assignment, between 3 September 2021 and 16 December 2021. Further details are available on the course page. Student editor(s): Faytj3920 (article contribs).
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)
Chronic cerebrospinal venous insufficiency
I propose to add this new source:
Best regards. --BallenaBlanca (talk) 13:45, 5 January 2016 (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)
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: [1]. 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)
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)
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 [3]
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)
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)
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)
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)
- 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)
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)
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)
FAR needed
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:[4]
- 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)
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:
- 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)
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
- cognitive is misspelled
- run-on sentence in there
- writing style is not concise
- Depression is not a cognitive symptom
- Fatigue is not cognitive
- Lhermitte's sign is not cognitive
- dizziness is not cognitive
- Musculoskeletal is misspelled
- ataxia is not a musculoskeletal symptom, primarily
- reflexes is not a musculoskeletal symptom
- Uhthoff's phenomenon is not a specific to sensation
- pins and needles are listed separate from paresthesias, although that is paresthesia
- 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:
- 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.
- 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.
- I have no opinion on that currently. I couldn't selectively undo certain edits. Sorry for taking that out.
- No comment about the citation style. I am new to this article.
- 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:
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)
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)