Regular review: Drug treatment of multiple sclerosis

BMJ 2000;321:490-4 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 mecha nisms 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 ran domised, placebo controlled studies, and we address several questions that still generate wide interest in rela tion 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.