Drug treatment of multiple sclerosis

Multiple sclerosis is the most common cause of chronic neurological disability in young adults, with a prevalence of about 1 in 1000. 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 favourable impact on the natural course of the disease (disease modifying drugs). We discuss the evidence available from large randomised, placebo controlled studies, and we address several questions that still generate wide interest in relation to treatment with disease modifying drugs. Treatment of symptoms and rehabilitation, which still remain the mainstay of treatment for most patients with multiple sclerosis, are not reviewed here. #### Summary points We have concentrated mainly on drugs that have been specifically approved for use in multiple sclerosis. Our sources included papers from Medline, information from international meetings on multiple sclerosis, and ongoing discussions with colleagues. ### Clinical course Multiple sclerosis usually manifests clinically in the third or fourth decade, typically presenting with a relapsing-remitting course which, after a period of time (average 5–15 years), in most patients is followed by …