Patient Selection and Criteria

There was considerable discussion by our committee concerning the need to quantify the actual amount of tissue damage in multiple sclerosis (MS). The pathologic process involves inflammation, demyelination, and gliosis. A continuing goal in this area should be the development of a system to measure directly the various components of tissue damage. Clinical symptoms in MS are related to the location of the lesion and not to the quantity of pathologic activity. Though not a reliable index of the extent of disease, such clinical evaluation is the best quantitation that is currently available. In the future, the use of nuclear magnetic resonance (NMR) and computed tomographic (CT) scanning might well help in this determination. Evoked potentials and CSF analysis are not likely to be helpful in this regard, with the possible exception of CSF levels of myelin basic protein and its fragments and changes in the rate of CSF