Drug treatment of multiple sclerosis

Abstract

Multiple sclerosis is the most common cause of chronic neurologic disability in young adults, with a prevalence of about 1 in 1,000. About 50% of patients are unable to walk without assistance 15 years after onset. As yet, no treatment can halt the accumulation of disability. In recent years, however, there has been substantial progress in understanding the pathogenetic mechanisms of the disease and in developing techniques to monitor treatment. Based on this progress, treatments were developed that have a favorable effect on the natural course of the disease (disease-modifying drugs). We discuss the evidence available from large randomized, placebo-controlled studies, and we address several questions that still generate wide interest in relation to treatment with disease-modifying drugs. The treatment of symptoms and rehabilitation, which still remain the mainstay of care of most patients with multiple sclerosis, are not reviewed here.