CHOOSING DRUG-THERAPY FOR MULTIPLE-SCLEROSIS - AN UPDATE

Multiple sclerosis (MS) is an immunologically mediated disorder in whi ch inflammation and demyelination of the central nervous system white matter are prominent features, resulting in various neurological signs and symptoms. In most patients, the course of the disease is initiall y characterised by relapses and remissions. In patients with chronic d isease there is a tendency towards a gradually progressive disease cou rse. MS relapses can best be treated with a course of high dose intrav enous methylprednisolone. In ambulatory patients with relapsing remitt ing MS, partial prevention of relapses can be achieved by the use of i nterferon-beta-1a or -1b, whereas there is (as yet less convincing) ev idence that glatiramer acetate (copolymer-1) might also be effective. At this time, there is no proof that these drugs are effective in pati ents with progressive MS, although trial results are expected to be av ailable soon. In patients with rapidly progressive disease, it might b e worth considering the effect of methotrexate. Future treatment optio ns include new strategies to interfere with disease-relevant, specific or nonspecific immune mechanisms as well as drugs that might promote remyelination. In spite of the advances that have been made over the p ast few years, symptomatic treatment, including a multidisciplinary re habilitation approach, remains the mainstay of treatment of the majori ty of MS patients.