NONSPECIFIC IMMUNOSUPPRESSION IN MULTIPLE-SCLEROSIS

Several series of arguments favor at least partial efficacy of immunos uppression in multiple sclerosis. immunosuppression can often treat ex perimental autoimmune encephalitis, and imperfect model of multiple sc lerosis. Certain agents have been shown to affect the pathophysiologic al processes seen indirectly on magnetic resonance imaging (mitoxantro ne and Campath, for example). Therapeutic trials have their methodolog ical weaknesses but do allow certain conclusions. The progressive form s of multiple sclerosis are the most widely studied. Massive but short -term immunosuppression does not appear to affect the course of progre ssion but prolonged immunosuppression would appear to slow down the pr ocess, at least in responders. The effect on disease progression is mo dest and preference should go to well-tolerated treatments. Immunosupp ression appears to effectively decrease the number of acute episodes a nd reduce the number of new lesions detectable by magnetic resonance i maging. The effect of immunosuppression is limited however by the fact that the clinical course of progressive forms depends less on the dev elopment of new lesions than on an aggravation of the demyelinization process and possible axon loss within constituted lesions. This is a f urther argument favoring early immunosuppressive treatment at a stage when it can be most effective.