Recent progress in the diagnosis and treatment of multiple sclerosis

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.