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Recent progress in the diagnosis and treatment of multiple sclerosis
1Department of Medicine, The University of Queensland, Royal Brisbane Hospital, Brisbane, Australia
Abstract:
Magnetic resonance imaging (MRI) now provides valuable diagnostic and prognostic information for the management of multiple sclerosis (MS) but the diagnosis still largely rests on the clinical features of central nervous system (CNS) lesions disseminated in time and place. Recent histological and MRI studies indicate that extensive axonal damage can occur in MS, even early in the disease course, and is likely to be an important cause of accumulating disability. Several immunomodulating agents have now been shown to have beneficial effects in MS. High dose intravenous or high dose oral methylprednisolone therapy accelerates recovery from attacks of relapsing-remitting MS, but at present there is no convincing evidence that standard dose (intermediate dose) oral corticosteroid therapy is beneficial for such attacks. Interferon beta, copolymer 1 (glatiramer acetate) and i.v. immunoglobulin therapy each significantly reduce the frequency of attacks of relapsing-remitting MS. Interferon beta also inhibits the progression of disability in relapsing-remitting MS and secondary progressive MS, but its effect on primary progressive MS is unknown. Oral low dose methotrexate therapy slows the progression of disability in secondary progressive MS and possibly in primary progressive MS, but it is likely that the currently used dosage (7.5 mg weekly) is suboptimal. Further research is needed to determine the optimal doses and combinations of the above therapies in MS and to develop better therapies, particularly for primary progressive MS. Copyright 1999 Harcourt Publishers Ltd.
Insights
Multiple sclerosis (MS) management benefits from MRI, but diagnosis relies on clinical signs. Early axonal damage contributes to disability, while immunomodulating therapies show promise for managing MS relapses and progression.
Area of Science:
- Neurology and Neuroscience
- Immunology
- Radiology
Background:
- Multiple Sclerosis (MS) diagnosis relies on clinical presentation of central nervous system (CNS) lesions disseminated in time and place.
- Extensive axonal damage, evident in early MS, significantly contributes to accumulating disability.
- Magnetic Resonance Imaging (MRI) offers crucial diagnostic and prognostic insights for MS management.
Purpose of the Study:
- To review the current understanding of MS diagnosis, pathology, and therapeutic interventions.
- To evaluate the efficacy of various immunomodulating agents in managing MS.
- To identify areas requiring further research for optimizing MS treatment strategies.
Main Methods:
- Review of recent histological and MRI studies on MS pathology and disease course.
- Analysis of clinical trial data for immunomodulating therapies in different MS subtypes.
- Assessment of corticosteroid and disease-modifying therapies for relapsing-remitting and progressive MS.
Main Results:
- High-dose methylprednisolone accelerates recovery from relapses; standard-dose corticosteroids lack proven benefit.
- Interferon beta, glatiramer acetate, and IV immunoglobulin reduce relapse frequency in relapsing-remitting MS.
- Interferon beta slows disability progression in relapsing-remitting and secondary progressive MS; methotrexate shows potential for progressive forms.
Conclusions:
- Current immunomodulating therapies offer benefits for MS management, particularly in reducing relapses and slowing disability progression.
- Optimal dosing and combinations of therapies require further investigation.
- Development of improved treatments, especially for primary progressive MS, remains a critical unmet need.