Controversias en neuroinmunología: esclerosis múltiple y otras enfermedades desmielinizantes

Multiple sclerosis (MS) is the most prevalent demyelinating disease affecting the central nervous system. In the past two decades, significant milestones have been achieved in this domain, including the identification of critical immunological pathways, novel biomarkers, and effective immunotherapies. Nonetheless, several areas of uncertainty and challenges persist.Globally, there has been a notable increase in MS cases. In Colombia, recent studies indicate a rise in prevalence from fewer than 5 cases per 100,000 inhabitants to 7.5 cases per 100,000. It is imperative for neurologists to stay informed about current treatments to offer appropriate guidance to these patients.This review analyzes eight pertinent controversies surrounding MS and other demyelinating diseases, based on the most current scientific evidence. Topics explored include the discontinuation of therapy in older adults, the role of genetic testing in diagnosis, family planning considerations, and the prevention of postpartum relapses. Additionally, it examines indications for stem cell therapy, risks of malignancy associated with immunotherapy, management strategies for lymphopenia, and approaches to mitigate rebound effects after discontinuing disease-modifying therapy. Each controversy is supported by a thorough analysis and practical recommendations aimed at informing decision-making in daily clinical practice and adapting to the realities of countries like ours, where advancements in neurological training and access to treatments are crucial.