Current treatment options in multiple sclerosis.

Advances in our understanding of the pathogenesis of multiple sclerosis (MS) lesions are leading to the development of more targeted therapies. Axonal transection is likely an important cause of accumulating disability in disease progression and suggests the importance of early and aggressive therapy. Early treatment with disease-modifying therapy should be considered in patients with first episode of demyelination and presence of MRI lesions consistent with MS. Intravenous steroids are the mainstay of treatment of acute MS exacerbations. Although their benefits must be weighed against the potential for complications, natalizumab and mitoxantrone significantly decrease relapses and MRI lesions in patients with relapsing MS. Many new therapies, including oral and infrequently administered infusion therapies, are currently in phase III trials and will likely become available over the next 3 to 4 years.