MULTIPLE-SCLEROSIS - DIAGNOSTIC PROCEDURE S AND NEW THERAPEUTIC DEVELOPMENTS

The diagnosis of multiple sclerosis remains a clinical one. It is base d on the documentation of lesions at two or more sites of the CNS and of two or more relapses in relapsing-remitting disease, or persistant deterioration for 6 months in primarily chronic-progressive disease. B ecause no symptom and no result of a paraclinical investigation is spe cific enough, a careful differential diagnostic work up by a physician competent in clinical neurology is essential. CSF examination, blood serology, MRI and in some cases evoked potentials may help in this wor k-up. The results of recently completed controlled trials suggest that , besides high dose steroid treatment of acute relapses, immunomodulat ory treatments may help to improve the prognosis in the relapsing-remi tting phase of the disease. Treatments that will enter clinical practi ce in the next year or two are recombinant interferon beta-1b and -1a and perhaps copolymer 1. Non-selective immunosuppressants (azathioprin e, in more severe cases other substances with more intensive cytostati c activity) also have a place in selected cases. The efficacy of such treatment in secondary chronic-progressive disease as well as the indi cation for very early treatment are now under investigation. Some poss ible future developments in diagnosis and therapy of MS are discussed.