Letter to the Editor: Importance of Early Treatment of Multiple Sclerosis Exacerbations

To the Editor

There is one important area of multiple sclerosis (MS) research that is routinely ignored, which is actually easily feasible and could be carried out in any large MS clinic: the time from onset of an attack to treatment and the change in outcome with early versus delayed treatment. Preliminary results could be obtained through chart review. I believe early treatment results in a better outcome. The faster you treat and stop the immunologic attack, the less the damage. Many neurologists treat attacks as though the initiation of treatment is not urgent. In my opinion and experience, the faster you can begin treatment, the better the outcome. We need both retrospective and prospective studies in this area. As in stroke, I believe time is brain!

Addendum: Since submission, the following article has been published indicating that, in neuromyelitis optica spectrum disorders optic neuritis, time is vision: Stiebel-Kalish H, Hellmann MA, Mimouni M, et al. Does time equal vision in the acute treatment of a cohort of AQP4 and MOG optic neuritis? Neurol Neuroimmunol Neuroinflamm. 2019;6:e572.