New therapeutic strategies in multiple sclerosis.

Until a few years ago, the focus of MS therapy was mainly on the symptomatic approach. Several rigorous clinical trials concerning mainly relapsing-remitting forms were conducted recently. As a result of these, therapeutical views have changed. Elevated doses of methylprednisolone, used during a short period have significantly improved the handicap; but impact over a longer time is unknown. It has now been demonstrated that beta interferons reduce the frequency of relapses, modify the handicap favourably and improvements are clearly shown on MRIs. Therefore MRI has become an invaluable tool for the evaluation of the efficacy of new drugs. Recently, there have been positive results made in progressive MS. Two other drugs, Copolymer and Immunoglobulins have also shown encouraging results but other studies are still necessary. The role of some immunosuppressive agents, but mainly the role of mitoxant one are now better understood. These results are encouraging but they have also raised a lot of questions such as: how can these drugs be used in other forms of MS; what is their long-term impact on the disease; what is the mechanism of their action; what is the etiopathogeny of MS? Clinical trials are being conducted to answer these questions and to study the usefulness of combined therapies. Even though these results have been positive, other therapies which focus on spasticity, fatigue, sphincter, dysfunction and psychosocial problems must not be neglected (C) 1999 Elsevier, Paris.