Looking at a Lack of Updated Guidelines


With treatment guidelines from the American Academy of Neurology last updated in 2002 the panelists discuss the need for updates a dozen years later.

Stephen Krieger, MD, says he believes one of the reasons there has not been an update to the guidelines is that since they were last updated so much of the treatment field has changed.

“In a sense what we’ve been talking about this whole time are the nuances, the fact that there are so many factors that go into the decision — patient-driven factors, disease-driven factors, comorbidities, risk profile,” he notes. “And we don’t yet have a biologically-driven way of making these decisions that would really let us have an algorithm or guidelines the way there are in let’s say oncology, which I think has done a brilliant job of being able to do this in an evidence-based way.”

Patricia Coyle, MD, says neurologists treating patients with multiple sclerosis have been “a little bit derelict,” in not updating the guidelines.

“I do think we have enough of a basis to get some central principles about how quickly you want to start treatment. What prognostic factors do you think about? How are you going to judge disease activity? Some basic principles that we could come up with and agree that would be valuable.”

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