Document Type : Original Article


1 Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Neurology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Neurology, Booalicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran

5 Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

6 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

7 Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

8 Center for Clinical Research and Development, Ghaem International Hospital, Rasht, Iran

9 Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

10 Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran

11 Department of Neurology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran

12 Department of Neurology, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran

13 Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran


Background: People with multiple sclerosis (MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). 
In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical cases with different physical and cognitive conditions.
Methods: Opinions of 20 MS specialists regarding the best approach to 6 case scenarios (with different clinical, cognitive, and imaging characteristics) were gathered via a form.
Results: The estimated kappa of 0.16 [95% confidence interval (CI): 0.159-0.163; P < 0.001] suggested a poor degree of agreement on the treatment choice among the professionals.
Conclusion: Although most specialists agreed with treatment escalation in cases with cognitive impairment, there was no general agreement. Furthermore, there was not enough clinical evidence in the literature to develop consensus guidelines on the matter.


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