…This is consistent with the criteria outlined in treatment optimization recommendations (Freedman et al. Can J Neurol Sci 2020;47:437-455), but fails to explain the suboptimal use of higher-efficacy DMTs even when clinically indicated. Several other factors may play a role in the underusage of highly effective therapies. Neurologists who do not specialize in MS are less likely to escalate treatment even in cases of severe MS (Saposnik et al. Mult…

…s-covid-19/enhancing-access-principle-based-recommendations-equity/based-recommendations-equity-en.pdf). For example, a NARCOMS survey found that telehealth video visits were less common among disadvantaged groups, such as the elderly and those with greater impairments (Marrie et al. Neurol Clin Pract 2022;12:223-233). Telephone contact can be made in rural areas where videoconferencing is unavailable but generally provides suboptimal care (Giacom…