Therapeutic management of multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the central nervous system in which acute inflammatory reactions directed at proteins on the myelin coating of nerve fibers and the oligodendrocytes which produce it, results in cumulative damage to both the myelin and the nerve fibers or axons themselves. Destruction of the axons leads to degeneration of the related nerve cells and is believed to underlie the development of the permanent neurological disability which occurs later in the disease course. Until recently, only symptomatic therapies were available to mitigate the impact of the neurological impairments and to try to hasten recovery from acute attacks. The past decade, however, has been marked by the availability of disease-modifying drugs (DMDs) which modify immune responses to reduce the inflammatory damage that occur in the disease. These drugs appear to be changing the natural history by reducing and mitigating the development of permanent neurological disability. Consequently, modern MS therapy as practiced by neurologists who specialize in the treatment of this disease, employs a comprehensive approach, combining symtomatic agents to optimize function and quality of life and reduce risks of later secondary complications. Optimization and early initiation of immune-based DMDs limit the degree of axonal destruction and consequent risk of permanent disability. This brief review describes the elements of the comprehensive approach to MS therapy and illustrates the implications and importance of an early and active approach to management of this chronic and in some cases, disabling disease.