[Treatment of multiple sclerosis]

In recent years there have been important advances in the treatment of multiple sclerosis (MS), on the demonstration that specific therapies may modify the long term evolution of this disease. There is however still no treatment which definitively stops its evolution and thus there are numerous ongoing studies searching for new therapeutic options. For the acute phase of this disease there is generalized consensus on the use of corticoids. Nonetheless it is not unanimous as to the type, dose or therapeutic schedule of these drugs although the most commonly used drug at present is intravenous methylprednisolone. To prevent the evolution of remittent MS beta interferon is considered as the treatment of choice. However there are questions as to which cases would benefit most and when it should be used in addition to the type of beta interferon, the dose and the route of administration, etc. A possible alternative may be the use of copolimere-1 or azathioprine. The use of interferon beta 1-b has recently been shown to be useful in the secondarily progressive forms of MS. Up to the present the therapies used for primarily progressive MS have been deceiving since no drug has shown clear benefits despite their side effects. In cases of rapid evolution mitozantrone, methotrexate or cyclophosphamide may be considered (with periodic maintenance schedules). Current studies are aimed at: a) combining different treatments which have shown partial effects when used separately, b) searching for immunomodulators which are more specific than indiscriminated immunosuppression, or c) finding therapies promoting remyelinization. The symptomatic, pharmacologic or rehabilitation treatment continue to be fundamental in the quality of life of patients with MS.