Magnetic resonance imaging (MRI) now provides valuable diagnostic and progn
ostic information for the management of multiple sclerosis (MS) but the dia
gnosis still largely rests on the clinical features of central nervous syst
em (CNS) lesions disseminated in time and place. Recent histological and MR
I studies indicate that extensive axonal damage can occur in MS, even early
in the disease course, and is likely to be an important cause of accumulat
ing disability, Several immunomodulating agents have now been shown to have
beneficial effects in MS. High dose intravenous or high dose oral methylpr
ednisolone therapy accelerates recovery from attacks of relapsing-remitting
MS, but at present there is no convincing evidence that standard dose (int
ermediate dose) oral corticosteroid therapy is beneficial for such attacks.
Interferon beta, copolymer 1 (glatiramer acetate) and i.v. immunoglobulin
therapy each significantly reduce the frequency of attacks of relapsing-rem
itting MS. Interferon beta also inhibits the progression of disability in r
elapsing-remitting MS and secondary progressive MS, but its effect on prima
ry progressive MS is unknown. Oral low dose methotrexate therapy slows the
progression of disability in secondary progressive MS and possibly in prima
ry progressive MS, but it is likely that the currently used dosage (7.5 mg
weekly) is suboptimal. Further research is needed to determine the optimal
doses and combinations of the above therapies in MS and to develop better t
herapies, particularly for primary progressive MS. (C) 1999 Harcourt Publis
hers Ltd.