A review of current and emerging therapeutic strategies in multiple sclerosis.

Multiple sclerosis (MS) is a chronic immune-mediated disease that potentially requires symptomatic and disease-modifying therapies. Numerous symptoms (eg, fatigue, spasticity, depression, bowel and bladder dysfunction, pain, and impaired mobility) are associated with the neurologic damage that results from MS. Several therapies (eg, modafinil, dalfampridine, baclofen, diazepam, gabapentin, opioids) are used for symptomatic treatment of disability and symptoms, but these do not improve disease outcome. Intravenous corticosteroids (with or without an oral corticosteroid taper) are used in the management of MS exacerbations, but do not appear to affect the degree of improvement from acute exacerbations. A more definitive therapy for MS should reduce relapse rate, prolong remission, limit the onset of new MS lesions, and postpone the development of long-term disability. The currently available MS disease-modifying therapies have been shown to reduce relapse rate, have beneficial effects on magnetic resonance imaging measures, and delay accumulation of disability. In addition, a number of agents are in development, but thus far no beneficial agent has been established in primary-progressive MS.