2 articles
The therapeutic landscape of multiple sclerosis has undergone a remarkable transformation over the past two decades. The paradigm has shifted from reliance on moderate-efficacy, first-generation injectable therapies toward earlier adoption of high-efficacy disease-modifying treatments, particularly in relapsing forms of MS. This evolution reflects an increasing focus on early intensive treatment strategies aimed at preserving long-term neurological function and brain health.
This narrative review synthesizes recent global evidence on progress in disease-modifying treatments across all multiple sclerosis phenotypes, drawing from randomized controlled trials, real-world studies, and expert consensus guidelines. In addition, it includes a comparative health policy analysis assessing DMT availability, access, and implementation in Romania and the Republic of Moldova, based on national formularies, reimbursement frameworks, and care delivery models.
Globally, the MS treatment algorithm has been reoriented toward early intensive treatment, supported by emerging evidence favoring high-efficacy therapies in the early disease course. While many countries have aligned their protocols accordingly, regional discrepancies persist. Romania, as an EU member, has expanded patient access to 16 reimbursed therapies and biomarker-driven monitoring, and has developed a network of specialized Multiple Sclerosis centers. Conversely, the Republic of Moldova faces structural and economic barriers that restrict access to high-efficacy treatments, advanced diagnostics, and multidisciplinary care—factors contributing to delayed treatment and suboptimal outcomes.
Understanding both global innovations and regional realities is necessary to place current Multiple Sclerosis care in context. Further advancements in science, health policy, and infrastructure will ultimately determine how effectively different nations can convert therapeutic progress into actual improvements in patient outcomes.
Multiple sclerosis is an autoimmune disease characterized by chronic inflammation with progressive demyelination and axonal dysfunction. The disease affects about 1 million young adults, 2/3 of which are women of childbearing age, with all patients developing irreversible neurological dysfunction. There is observed a stagnation of the disease during pregnancy, with the return of exacerbations in the postpartum period. Contemporary specialty textbooks neither confirm nor deny the safety of neuraxial anesthesia in patients with central nervous system diseases.
We present the clinical case of a 25-year-old nullipara pregnant (36 weeks and 6 days gestation age), known with relapsing-remitting multiple sclerosis and epilepsy. The woman has relapsing multiple sclerosis symptoms during the last 6 days, reason why is urgently consulted by the anesthesiologist for cesarean delivery.
The article describes the technique of epidural anesthesia for the obstetrical patient with multiple sclerosis and the course of the perianesthetic evolution, including 1-year follow-up after cesarean section.
With the aim of avoiding potential influences on the evolution and progression of the disease, clinical judgment and the choice of anesthetic technique (general vs. neuraxial) depends on several factors: vaginal delivery or caesarean section, the presence of contextual clinical modifiers (native or drug-induced coagulopathy, infection), the urgency of the intervention, and the patient’s cooperation. In case of parturients with multiple sclerosis, all the risks should be rigorously evaluated: on one hand - the additional risk of general anesthesia (risk of aspiration, potential loss of airway control, critical desaturations) and on the other hand - the risk of hypothetical local anesthetic toxicity in the case of neuraxial techniques.
Neuraxial epidural anesthesia is a safe technique in obstetric patients with multiple sclerosis.