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MRI McDonald criteria, RR PP SP forms, interferons natalizumab ocrelizumab, and rehabilitation in Quebec.\">\n<meta name=\"keywords\" content=\"scl\u00e9rose en plaques, SEP, scl\u00e9rose en plaques traitement, SEP r\u00e9mittente r\u00e9currente, SEP progressive, natalizumab SEP, ocrelizumab SEP, IRM SEP, crit\u00e8res McDonald, scl\u00e9rose en plaques Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n 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34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Multiple sclerosis (MS) is the most common chronic non-traumatic neurological disease of young adults in northern and temperate countries, affecting around 1 in 500 people in Canada - which has one of the highest prevalence rates in the world, with around 90,000 Canadians affected (including almost 25,000 Quebecers). It is an autoimmune demyelinating inflammatory disease of the central nervous system (CNS) in which autoreactive T lymphocytes cross the blood-brain barrier and attack myelin - the insulating lipid-protein sheath surrounding neuronal axons - leading to focal demyelination (plaques) + inflammation + progressive axonal loss in the brain + spinal cord + optic nerve. Its pathophysiology combines a polygenic genetic predisposition (HLA-DRB1*15:01 gene = main risk factor + 20-30 % heritability) with triggering environmental factors (low sun exposure + vitamin D deficiency + EBV - Epstein-Barr virus infection = quasi-necessary triggering factor according to recent data + smoking + obesity in adolescence) in young women aged 20 to 40 (F:H = 3:1). The most frequent clinical form (85 % of cases) is relapsing-remitting MS (RRMS), characterized by relapses (episodes of focal neurological deficit lasting more than 24 hours + complete or partial recovery) interspersed with phases of remission + evolving over 15-20 years into secondarily progressive MS (SPMS) in 50-60 % of untreated patients. The therapeutic revolution of the last twenty years - the introduction of highly effective disease-modifying therapies (natalizumab + alemtuzumab + ocrelizumab + ofatumumab + cladribine) - has profoundly altered the prognosis: an early, aggressive therapeutic approach (high efficacy first) in patients at risk of progression significantly reduces the accumulation of long-term disability.\n <\/div>\n\n <h2>Clinical forms<\/h2>\n <ul class=\"co-list\">\n <li><strong>SEP recurring transmitter (SEP-RR - 85 %):<\/strong> flare-ups (new symptoms or worsening of existing symptoms for \u2265 24 hours + in the absence of fever + more than 30 days apart) + partial or complete recovery between flare-ups + no progression between flare-ups + disease-modifying therapy = standard of care + most treated form<\/li>\n <li><strong>Secondary Progressive Multiple Sclerosis (SPMS):<\/strong> follows a RRMS in 50-60 % cases (untreated) + continuous clinical progression without distinct relapses + or with superimposed relapses (active SPMS) + disease-modifying treatment: siponimod (Mayzent\u00ae) + ocrelizumab in active forms<\/li>\n <li><strong>Fundamentally progressive SEP (SEP-PP \u2014 10\u201315 %):<\/strong> Clinical progression from the beginning without identifiable relapses + typical presentation: progressive spastic paraparesis + man \u2265 40 years old ++ + disease-modifying treatment: ocrelizumab (Ocrevus\u00ae) = only approved drug for PPMS (ORATORIO study)<\/li>\n <li><strong>Clinically Isolated Syndrome (CIS)<\/strong> First demyelinating episode (optic neuritis + myelitis + brainstem syndrome) + does not yet meet McDonald criteria for MS + if MRI is already suggestive \u2192 early initiation of disease-modifying treatment reduces the risk of conversion to definite MS.<\/li>\n <li><strong>Radiologically isolated syndrome (RIS):<\/strong> MRI anomalies suggestive of MS + incidentally discovered + no neurological symptoms + risk of conversion to CIS or MS: 30\u201350 % within 5 years<\/li>\n <\/ul>\n\n <h2>Clinical symptoms according to plaque location<\/h2>\n <ul class=\"co-list\">\n <li><strong>Retrobulbar optic neuritis (RON)<\/strong> Pain on eye movement + progressive unilateral decrease in visual acuity + dyschromatopsia (desaturated red) + relative afferent pupillary defect (RAPD) + Uhthoff's sign (worsening with heat or exertion) + first sign of MS in 20 % of cases + recovery in 4-12 weeks + IV corticosteroids accelerate recovery without improving it long-term<\/li>\n <li><strong>Partial transverse myelitis:<\/strong> Sensorimotor deficit of the lower limbs + sphincter dysfunction + Lhermitte's sign (electric shock down the spine on neck flexion = pathognomonic of cervical plaques) + sensory level + spastic paraparesis<\/li>\n <li><strong>Brainstem and cerebellum involvement:<\/strong> diplopia (internuclear \u2192 INO = internuclear ophthalmoplegia due to plaque on the MLF) + vertigo + ataxia + nystagmus + dysarthria + dysphagia<\/li>\n <li><strong>Constitutional symptoms:<\/strong> chronic fatigue (the most frequent symptom \u2014 present in 80 % of cases) + cognitive disorders (memory + attention + processing speed) + depression + bladder disorders (urgency + incontinence + retention) + spasticity + neuropathic pain + sexual dysfunction + Uhthoff's phenomenon<\/li>\n <\/ul>\n\n <h2>Diagnostic \u2014 McDonald Criteria 2017<\/h2>\n <ul class=\"co-list\">\n <li><strong>Fundamental principle:<\/strong> demonstrate the dissemination in time (DIT) AND in space (DIS) of CNS lesions, excluding all other diagnoses<\/li>\n <li><strong>Dissemination in Space (DIS):<\/strong> lesions in \u2265 2 of the 4 typical MS regions: periventricular + juxtacortical\/cortical + infratentorial + spinal cord + one symptomatic lesion<\/li>\n <li><strong>Dissemination over time (DOT)<\/strong> simultaneous presence of contrast-enhancing (active) lesions + and non-enhancing (old) lesions on the same MRI + or new T2 or Gd+ lesion on follow-up MRI + or oligoclonal bands in CSF (reflects a chronic intrathecal immune response)<\/li>\n <li><strong>Cerebral and spinal MRI<\/strong> Periventricular ovoid T2\/FLAIR hyperintensities (Dawson's fingers perpendicular to the ventricles) + juxtacortical lesions + infratentorial lesions + spinal cord lesions + gadolinium enhancement = active lesion (BBB breakdown) + global cerebral atrophy to measure<\/li>\n <li><strong>LCR<\/strong> bandes oligoclonales (BOC) IgG dans le LCR (absentes du s\u00e9rum) = marqueur de l'inflammation intrath\u00e9cale chronique + pr\u00e9sentes dans 85\u201395 % des SEP + index IgG \u00e9lev\u00e9 + pl\u00e9iocytose lymphocytaire l\u00e9g\u00e8re<\/li>\n <li><strong>Evoked potentials<\/strong> VEP (visual evoked potentials) \u2192 P100 latency prolongation = sign of optic pathway demyelination, even subclinical + SEP + BAEP + BAEP<\/li>\n <\/ul>\n\n <h2>Disease-modifying treatments \u2014 by efficacy<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Efficiency<\/th>\n <th>Drug<\/th>\n <th>Mechanism of action + remarks<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Moderate efficacy (first-line)<\/td>\n <td>Interferon beta-1a (Avonex\u00ae + Rebif\u00ae) + Interferon beta-1b (Betaseron\u00ae + Extavia\u00ae) + glatiramer acetate (Copaxone\u00ae) + dimethyl fumarate (Tecfidera\u00ae) + teriflunomide (Aubagio\u00ae)<\/td>\n <td>30\u201350% % reduction + well tolerated + long-term safety established + option for mild to moderate activity forms + used for 25\u201330 years<\/td>\n <\/tr>\n <tr>\n <td>High efficiency<\/td>\n <td>Natalizumab (Tysabri\u00ae \u2014 monthly IV) + fingolimod (Gilenya\u00ae \u2014 oral) + siponimod (Mayzent\u00ae \u2014 oral SEP-SP) + ozanimod (Zeposia\u00ae) + ponesimod (Ponvory\u00ae)<\/td>\n <td>Thump reduction of 50-70 % + natalizumab: anti-\u03b14-integrin \u2192 prevents T-cell passage into the CNS + risk of PML (progressive multifocal leukoencephalopathy \u2014 JC virus \u2014 risk stratified by anti-JCV serology + number of doses) + fingolimod: lymphocyte sequestration in lymph nodes<\/td>\n <\/tr>\n <tr>\n <td>Very high efficiency<\/td>\n <td>Ocrelizumab (Ocrevus\u00ae \u2014 IV every 6 months) + ofatumumab (Kesimpta\u00ae \u2014 SC monthly) + ublituximab (Briumvi\u00ae) + alemtuzumab (Lemtrada\u00ae \u2014 annual infusions \u00d7 2 years) + cladribine (Mavenclad\u00ae \u2014 oral \u00d7 2 years)<\/td>\n <td>70-90% % relapse reduction + ocrelizumab and ofatumumab: anti-CD20 \u2192 B-cell depletion + only approved drug for PPMS (ocrelizumab) + alemtuzumab: anti-CD52 \u2192 deep and prolonged T+B depletion + risk of secondary autoimmunity (thyroiditis + ITP + nephritis) + intensive monitoring<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Management of flares and symptoms<\/h2>\n <ul class=\"co-list\">\n <li><strong>IV corticosteroids for flare-ups:<\/strong> methylprednisolone 1 g\/day IV x 3-5 days \u2192 speeds recovery + does not alter recovery level at 6 months + does not prevent long-term sequelae + indicated for disabling relapses (ONN + myelitis + severe brainstem involvement) \u2192 no corticosteroids for minor, non-disabling relapses<\/li>\n <li><strong>Fatigue:<\/strong> amantadine 100 mg twice daily + modafinil (Alertec\u00ae) + aerobic exercise + treatment of concomitant depression and sleep disorders<\/li>\n <li><strong>Spasticity<\/strong> baclofen (oral + intrathecal pump for severe cases) + tizanidine + botulinum toxin + physical therapy + cannabinoids (nabiximols - Sativex\u00ae - Health Canada approval for MS spasticity)<\/li>\n <li><strong>Neuropathic pain:<\/strong> gabapentin + pregabalin + amitriptyline + duloxetine + carbamazepine (trigeminal neuralgia)<\/li>\n <li><strong>Bladder problems<\/strong> Anticholinergics (solifenacin + oxybutynin) for urgency + intermittent catheterization if retention + desmopressin for nocturia + intravesical onabotulinumtoxin A<\/li>\n <li><strong>Depression:<\/strong> ISRS + TCC + pr\u00e9sente chez 50 % des patients SEP + risque suicidaire accru<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>The \u00abtreat to target\u00bb concept in MS aims to achieve No Evidence of Disease Activity (NEDA): no relapses + no disability progression + no new MRI lesions. A \u00abhigh efficacy first\u00bb approach is increasingly recommended for young patients with active disease to prevent irreversible axonal lesion accumulation before recovery mechanisms are overwhelmed.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgent neurological consultation<\/div>\n <p>Consult a neurologist or go to the emergency room if new focal neurological symptoms appear\u2014painful unilateral visual loss + diplopia + limb weakness or numbness + balance problems + sudden onset sphincter dysfunction\u2014in a patient known to have MS (possible relapse) or in a young adult with no history (first demyelinating episode to investigate). For multidisciplinary follow-up of stabilized MS + management of chronic symptoms (fatigue + spasticity + pain) + and coordination with neurology teams, Clinique Omicron offers consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Physicians and Nurse Practitioners (NPs) at Clinique Omicron provide follow-up care for MS patients in coordination with neurology teams\u2014including monitoring the effects of disease-modifying therapies, managing chronic symptoms (fatigue, spasticity, neuropathic pain, bladder problems, depression), prescribing rehabilitation and physiotherapy, and referring to neurologists for relapses and treatment adjustments. Consultations are available at several service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not replace the advice of a doctor or a neurologist specializing in MS. The choice of disease-modifying treatment should be individualized according to the clinical form, disease activity, patient's risk profile, and preferences. Highly effective treatments require close monitoring to detect serious adverse effects early.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Scl\u00e9rose en plaques (SEP) : diagnostic, formes cliniques et traitements de fond | Clinique Omicron Neurologie & M\u00e9decine interne & M\u00e9decine de famille Scl\u00e9rose en plaques (SEP) La scl\u00e9rose en plaques (SEP) est la maladie neurologique chronique non traumatique la plus fr\u00e9quente chez l’adulte jeune dans les pays nordiques et temp\u00e9r\u00e9s, touchant environ 1 personne… <a href=\"https:\/\/cliniqueomicron.ca\/en\/sclerose-en-plaques\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Multiple Sclerosis (MS): Diagnosis, Clinical Forms, and Disease-Modifying Treatments | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Scl\u00e9rose en plaques (SEP) | Brossard | Clinique Omicron","_metasync_otto_description":"SEP \u00e0 Brossard : Clinique Omicron offre \u00e9valuation et traitement de la scl\u00e9rose en plaques. 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Nos profess...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Scl\u00e9rose en plaques (SEP) : diagnostic, formes cliniques et traitements de fond | Clinique Omicron","_aioseo_description":"La SEP est une maladie d\u00e9my\u00e9linisante auto-immune du SNC touchant 25 000 Qu\u00e9b\u00e9cois. Crit\u00e8res McDonald IRM bandes oligoclonales, formes RR SP PP, interf\u00e9rons natalizumab ocrelizumab high efficacy first au Qu\u00e9bec.","_metasync_seo_title":"Scl\u00e9rose en plaques (SEP) | Clinique Omicron","_metasync_seo_desc":"La scl\u00e9rose en plaques (SEP) est une maladie auto-immune du syst\u00e8me nerveux. 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\n\t\t\t\t\t\n\n\n\n\nMultiple Sclerosis (MS): Diagnosis, Clinical Forms, and Disease-Modifying Treatments | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Multiple sclerosis is an inflammatory demyelinating disease of the CNS. 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34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Multiple sclerosis (MS) is the most common chronic non-traumatic neurological disease of young adults in northern and temperate countries, affecting around 1 in 500 people in Canada - which has one of the highest prevalence rates in the world, with around 90,000 Canadians affected (including almost 25,000 Quebecers). It is an autoimmune demyelinating inflammatory disease of the central nervous system (CNS) in which autoreactive T lymphocytes cross the blood-brain barrier and attack myelin - the insulating lipid-protein sheath surrounding neuronal axons - leading to focal demyelination (plaques) + inflammation + progressive axonal loss in the brain + spinal cord + optic nerve. Its pathophysiology combines a polygenic genetic predisposition (HLA-DRB1*15:01 gene = main risk factor + 20-30 % heritability) with triggering environmental factors (low sun exposure + vitamin D deficiency + EBV - Epstein-Barr virus infection = quasi-necessary triggering factor according to recent data + smoking + obesity in adolescence) in young women aged 20 to 40 (F:H = 3:1). The most frequent clinical form (85 % of cases) is relapsing-remitting MS (RRMS), characterized by relapses (episodes of focal neurological deficit lasting more than 24 hours + complete or partial recovery) interspersed with phases of remission + evolving over 15-20 years into secondarily progressive MS (SPMS) in 50-60 % of untreated patients. The therapeutic revolution of the last twenty years - the introduction of highly effective disease-modifying therapies (natalizumab + alemtuzumab + ocrelizumab + ofatumumab + cladribine) - has profoundly altered the prognosis: an early, aggressive therapeutic approach (high efficacy first) in patients at risk of progression significantly reduces the accumulation of long-term disability.\n <\/div>\n\n <h2>Clinical forms<\/h2>\n <ul class=\"co-list\">\n <li><strong>SEP recurring transmitter (SEP-RR - 85 %):<\/strong> flare-ups (new symptoms or worsening of existing symptoms for \u2265 24 hours + in the absence of fever + more than 30 days apart) + partial or complete recovery between flare-ups + no progression between flare-ups + disease-modifying therapy = standard of care + most treated form<\/li>\n <li><strong>Secondary Progressive Multiple Sclerosis (SPMS):<\/strong> follows a RRMS in 50-60 % cases (untreated) + continuous clinical progression without distinct relapses + or with superimposed relapses (active SPMS) + disease-modifying treatment: siponimod (Mayzent\u00ae) + ocrelizumab in active forms<\/li>\n <li><strong>Fundamentally progressive SEP (SEP-PP \u2014 10\u201315 %):<\/strong> Clinical progression from the beginning without identifiable relapses + typical presentation: progressive spastic paraparesis + man \u2265 40 years old ++ + disease-modifying treatment: ocrelizumab (Ocrevus\u00ae) = only approved drug for PPMS (ORATORIO study)<\/li>\n <li><strong>Clinically Isolated Syndrome (CIS)<\/strong> First demyelinating episode (optic neuritis + myelitis + brainstem syndrome) + does not yet meet McDonald criteria for MS + if MRI is already suggestive \u2192 early initiation of disease-modifying treatment reduces the risk of conversion to definite MS.<\/li>\n <li><strong>Radiologically isolated syndrome (RIS):<\/strong> MRI anomalies suggestive of MS + incidentally discovered + no neurological symptoms + risk of conversion to CIS or MS: 30\u201350 % within 5 years<\/li>\n <\/ul>\n\n <h2>Clinical symptoms according to plaque location<\/h2>\n <ul class=\"co-list\">\n <li><strong>Retrobulbar optic neuritis (RON)<\/strong> Pain on eye movement + progressive unilateral decrease in visual acuity + dyschromatopsia (desaturated red) + relative afferent pupillary defect (RAPD) + Uhthoff's sign (worsening with heat or exertion) + first sign of MS in 20 % of cases + recovery in 4-12 weeks + IV corticosteroids accelerate recovery without improving it long-term<\/li>\n <li><strong>Partial transverse myelitis:<\/strong> Sensorimotor deficit of the lower limbs + sphincter dysfunction + Lhermitte's sign (electric shock down the spine on neck flexion = pathognomonic of cervical plaques) + sensory level + spastic paraparesis<\/li>\n <li><strong>Brainstem and cerebellum involvement:<\/strong> diplopia (internuclear \u2192 INO = internuclear ophthalmoplegia due to plaque on the MLF) + vertigo + ataxia + nystagmus + dysarthria + dysphagia<\/li>\n <li><strong>Constitutional symptoms:<\/strong> chronic fatigue (the most frequent symptom \u2014 present in 80 % of cases) + cognitive disorders (memory + attention + processing speed) + depression + bladder disorders (urgency + incontinence + retention) + spasticity + neuropathic pain + sexual dysfunction + Uhthoff's phenomenon<\/li>\n <\/ul>\n\n <h2>Diagnostic \u2014 McDonald Criteria 2017<\/h2>\n <ul class=\"co-list\">\n <li><strong>Fundamental principle:<\/strong> demonstrate the dissemination in time (DIT) AND in space (DIS) of CNS lesions, excluding all other diagnoses<\/li>\n <li><strong>Dissemination in Space (DIS):<\/strong> lesions in \u2265 2 of the 4 typical MS regions: periventricular + juxtacortical\/cortical + infratentorial + spinal cord + one symptomatic lesion<\/li>\n <li><strong>Dissemination over time (DOT)<\/strong> simultaneous presence of contrast-enhancing (active) lesions + and non-enhancing (old) lesions on the same MRI + or new T2 or Gd+ lesion on follow-up MRI + or oligoclonal bands in CSF (reflects a chronic intrathecal immune response)<\/li>\n <li><strong>Cerebral and spinal MRI<\/strong> Periventricular ovoid T2\/FLAIR hyperintensities (Dawson's fingers perpendicular to the ventricles) + juxtacortical lesions + infratentorial lesions + spinal cord lesions + gadolinium enhancement = active lesion (BBB breakdown) + global cerebral atrophy to measure<\/li>\n <li><strong>LCR<\/strong> bandes oligoclonales (BOC) IgG dans le LCR (absentes du s\u00e9rum) = marqueur de l'inflammation intrath\u00e9cale chronique + pr\u00e9sentes dans 85\u201395 % des SEP + index IgG \u00e9lev\u00e9 + pl\u00e9iocytose lymphocytaire l\u00e9g\u00e8re<\/li>\n <li><strong>Evoked potentials<\/strong> VEP (visual evoked potentials) \u2192 P100 latency prolongation = sign of optic pathway demyelination, even subclinical + SEP + BAEP + BAEP<\/li>\n <\/ul>\n\n <h2>Disease-modifying treatments \u2014 by efficacy<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Efficiency<\/th>\n <th>Drug<\/th>\n <th>Mechanism of action + remarks<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Moderate efficacy (first-line)<\/td>\n <td>Interferon beta-1a (Avonex\u00ae + Rebif\u00ae) + Interferon beta-1b (Betaseron\u00ae + Extavia\u00ae) + glatiramer acetate (Copaxone\u00ae) + dimethyl fumarate (Tecfidera\u00ae) + teriflunomide (Aubagio\u00ae)<\/td>\n <td>30\u201350% % reduction + well tolerated + long-term safety established + option for mild to moderate activity forms + used for 25\u201330 years<\/td>\n <\/tr>\n <tr>\n <td>High efficiency<\/td>\n <td>Natalizumab (Tysabri\u00ae \u2014 monthly IV) + fingolimod (Gilenya\u00ae \u2014 oral) + siponimod (Mayzent\u00ae \u2014 oral SEP-SP) + ozanimod (Zeposia\u00ae) + ponesimod (Ponvory\u00ae)<\/td>\n <td>Thump reduction of 50-70 % + natalizumab: anti-\u03b14-integrin \u2192 prevents T-cell passage into the CNS + risk of PML (progressive multifocal leukoencephalopathy \u2014 JC virus \u2014 risk stratified by anti-JCV serology + number of doses) + fingolimod: lymphocyte sequestration in lymph nodes<\/td>\n <\/tr>\n <tr>\n <td>Very high efficiency<\/td>\n <td>Ocrelizumab (Ocrevus\u00ae \u2014 IV every 6 months) + ofatumumab (Kesimpta\u00ae \u2014 SC monthly) + ublituximab (Briumvi\u00ae) + alemtuzumab (Lemtrada\u00ae \u2014 annual infusions \u00d7 2 years) + cladribine (Mavenclad\u00ae \u2014 oral \u00d7 2 years)<\/td>\n <td>70-90% % relapse reduction + ocrelizumab and ofatumumab: anti-CD20 \u2192 B-cell depletion + only approved drug for PPMS (ocrelizumab) + alemtuzumab: anti-CD52 \u2192 deep and prolonged T+B depletion + risk of secondary autoimmunity (thyroiditis + ITP + nephritis) + intensive monitoring<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Management of flares and symptoms<\/h2>\n <ul class=\"co-list\">\n <li><strong>IV corticosteroids for flare-ups:<\/strong> methylprednisolone 1 g\/day IV x 3-5 days \u2192 speeds recovery + does not alter recovery level at 6 months + does not prevent long-term sequelae + indicated for disabling relapses (ONN + myelitis + severe brainstem involvement) \u2192 no corticosteroids for minor, non-disabling relapses<\/li>\n <li><strong>Fatigue:<\/strong> amantadine 100 mg twice daily + modafinil (Alertec\u00ae) + aerobic exercise + treatment of concomitant depression and sleep disorders<\/li>\n <li><strong>Spasticity<\/strong> baclofen (oral + intrathecal pump for severe cases) + tizanidine + botulinum toxin + physical therapy + cannabinoids (nabiximols - Sativex\u00ae - Health Canada approval for MS spasticity)<\/li>\n <li><strong>Neuropathic pain:<\/strong> gabapentin + pregabalin + amitriptyline + duloxetine + carbamazepine (trigeminal neuralgia)<\/li>\n <li><strong>Bladder problems<\/strong> Anticholinergics (solifenacin + oxybutynin) for urgency + intermittent catheterization if retention + desmopressin for nocturia + intravesical onabotulinumtoxin A<\/li>\n <li><strong>Depression:<\/strong> ISRS + TCC + pr\u00e9sente chez 50 % des patients SEP + risque suicidaire accru<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>The \u00abtreat to target\u00bb concept in MS aims to achieve No Evidence of Disease Activity (NEDA): no relapses + no disability progression + no new MRI lesions. A \u00abhigh efficacy first\u00bb approach is increasingly recommended for young patients with active disease to prevent irreversible axonal lesion accumulation before recovery mechanisms are overwhelmed.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgent neurological consultation<\/div>\n <p>Consult a neurologist or go to the emergency room if new focal neurological symptoms appear\u2014painful unilateral visual loss + diplopia + limb weakness or numbness + balance problems + sudden onset sphincter dysfunction\u2014in a patient known to have MS (possible relapse) or in a young adult with no history (first demyelinating episode to investigate). For multidisciplinary follow-up of stabilized MS + management of chronic symptoms (fatigue + spasticity + pain) + and coordination with neurology teams, Clinique Omicron offers consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Physicians and Nurse Practitioners (NPs) at Clinique Omicron provide follow-up care for MS patients in coordination with neurology teams\u2014including monitoring the effects of disease-modifying therapies, managing chronic symptoms (fatigue, spasticity, neuropathic pain, bladder problems, depression), prescribing rehabilitation and physiotherapy, and referring to neurologists for relapses and treatment adjustments. Consultations are available at several service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not replace the advice of a doctor or a neurologist specializing in MS. The choice of disease-modifying treatment should be individualized according to the clinical form, disease activity, patient's risk profile, and preferences. Highly effective treatments require close monitoring to detect serious adverse effects early.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Scl\u00e9rose en plaques (SEP) : diagnostic, formes cliniques et traitements de fond | Clinique Omicron Neurologie & M\u00e9decine interne & M\u00e9decine de famille Scl\u00e9rose en plaques (SEP) La scl\u00e9rose en plaques (SEP) est la maladie neurologique chronique non traumatique la plus fr\u00e9quente chez l’adulte jeune dans les pays nordiques et temp\u00e9r\u00e9s, touchant environ 1 personne… <a href=\"https:\/\/cliniqueomicron.ca\/en\/sclerose-en-plaques\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Multiple Sclerosis (MS): Diagnosis, Clinical Forms, and Disease-Modifying Treatments | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Scl\u00e9rose en plaques (SEP) | Brossard | Clinique Omicron","_metasync_otto_description":"SEP \u00e0 Brossard : Clinique Omicron offre \u00e9valuation et traitement de la scl\u00e9rose en plaques. Prenez rendez-vous pour une consultation personnalis\u00e9e.","_metasync_otto_keywords":"scl\u00e9rose en plaques, sympt\u00f4mes scl\u00e9rose, traitement scl\u00e9rose, consultation m\u00e9dicale, \u00e9valuation m\u00e9dicale, services sant\u00e9, suivi m\u00e9dical, Clinique Omicron","_metasync_otto_og_title":"Sclerose En Plaques | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Scl\u00e9rose en plaques (SEP) Scl\u00e9rose en plaques (SEP) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos profess...","_metasync_otto_twitter_title":"Sclerose En Plaques | Clinique Omicron","_metasync_otto_twitter_description":"Scl\u00e9rose en plaques (SEP) Scl\u00e9rose en plaques (SEP) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos profess...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Scl\u00e9rose en plaques (SEP) : diagnostic, formes cliniques et traitements de fond | Clinique Omicron","_aioseo_description":"La SEP est une maladie d\u00e9my\u00e9linisante auto-immune du SNC touchant 25 000 Qu\u00e9b\u00e9cois. Crit\u00e8res McDonald IRM bandes oligoclonales, formes RR SP PP, interf\u00e9rons natalizumab ocrelizumab high efficacy first au Qu\u00e9bec.","_metasync_seo_title":"Scl\u00e9rose en plaques (SEP) | Clinique Omicron","_metasync_seo_desc":"La scl\u00e9rose en plaques (SEP) est une maladie auto-immune du syst\u00e8me nerveux. Sympt\u00f4mes, diagnostic par IRM, traitements de fond et suivi m\u00e9dical.","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_imported_seo_title":"","_metasync_imported_seo_desc":"","_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-09-13T18:05:15+00:00\"}","_metasync_robots_advanced":"","_metasync_og_title":"Sclerose En Plaques | Clinique Omicron Qu\u00e9bec","_metasync_og_description":"Scl\u00e9rose en plaques (SEP) Scl\u00e9rose en plaques (SEP) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos profess...","_metasync_twitter_title":"Sclerose En Plaques | Clinique Omicron","_metasync_twitter_description":"Scl\u00e9rose en plaques (SEP) Scl\u00e9rose en plaques (SEP) est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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