Treatment of multiple sclerosis.

Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, with highly variable clinical course that most typically exhibits a relapsing-remitting pattern. Neuroimaging, pathological findings and response to available therapies are also not uniform. It commonly affects young adults and is usually characterized in the early years by acute relapses followed by partial or complete remission; in later years progressive and irreversible disability develops. The clinical course of MS is defined as relapsing-remitting (RRMS), primary progressive (PPMS), progressive relapsing (PRMS) and secondary progressive (SPMS). The treatment of RRMS is based on the use of immunosuppressive and immune-modulating therapy. Immunosuppressive agents have been used in multiple sclerosis for decades. Intravenous methylprednisolone is currently the treatment of choice for the relapses. The currently approved treatments for MS are disease-modifying agents, which only reduce the attack rate and delay progression in some patients and are believed to be effective only for the inflammatory component of the disease. Immunomodulating and immunosuppressive treatments are directed against the inflammatory process and are only partially effective. In RRMS, positive effects on disease activity have slowed disability progression, but in PPMS the same degree of effect of immunotherapies on relapses and active MRI lesions had little or no effects on the progression of disability. This partial failure could be explained by mechanisms of axonal damage at least partially independent from acute or chronic inflammation. This suggests that there is a need for better use of available treatments and the necessity of alternative new therapeutic options to stop disease progression and improve recovery mechanisms. The practicing neurologist must understand the MS spectrum and evaluate patient-specific factors to determine the best strategy for therapy.