În concluzie, sintetizând toate aspectele discutate mai sus, prin prisma datelor ştiinţifice actuale privind scleroza multiplă (afecţiune pentru care în mod particular toate normele privind diagnosticul şi tratamentul au un caracter istoric, limitat în timp, datorită multelor aspecte necunoscute încă, dar care vor fi descifrate o dată cu progresul rapid al cunoaşterii ştiinţifice) putem afirma în acest moment următoarele principii de diagnostic şi tratament:
Diagnosticul pozitiv de scleroză multiplă se face în principal pe baza datelor clinice şi a aspectului IRM conform criteriilor stabilite de McDonald şi colab. si revizuite. Celelalte investigaţii paraclinice devin necesare doar dacă pe baza acestor date nu se poate stabili certitudinea de diagnostic şi pentru realizarea diagnosticului diferenţial.
Stabilirea diagnosticului de SM certă implică stabilirea formei clinice şi a gradului de invalidare prin folosirea unor scale de evaluare specifice (EDSS).
Tratamentul puseului de SM (recădere, recidivă) se face de elecţie cu doze mari de glucocorticoizi administrate i.v. pe termen scurt.
Este demonstrat faptul ca initierea cat mai rapida a terapiei imunomodulatoare (in stadiul de CIS) poate reduce dizabilitatea pe termen scurt si lung.
Toate cazurile de SMRR au indicaţie de tratament imunomodulator de lungă durată pe termen nelimitat.
SM este o boală cronică, pe toată durata vieţii şi nu este cunoscută în prezent nici o raţiune de întrerupere a unui astfel de tratament, o dată început; dacă un anumit tip de tratament modificator al evoluţiei nu este tolerat sau eşuează, trebuie să se recurgă la o altă terapie cunoscută din aceeaşi categorie.
Evoluţia pacienţilor trebuie să fie supravegheată clinic şi prin IRM. Modificările sau adăugirile la tratament trebuie începute înainte de pierderea ireversibilă a unei funcţii neurologice.
Cazurile de SMSP necesită tratament agresiv precoce. Tratamentul instituit tardiv la aceşti pacienţi (mai mulţi ani de la virajul formei RR spre SP) aduce beneficii clinice mult mai mici.
Nu este de aşteptat ca formele primar progresive de boală (SMPP) să răspundă semnificativ la un tratament modificator al evoluţiei bolii cunoscut în prezent.
Tratamentul simptomatic şi recuperator este tot atât de important ca şi tratamentul modificator al evoluţiei bolii din perspectiva ameliorării calităţii vieţii zilnice a pacientului şi familiei sale.
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