[Preventive treatment of multiple sclerosis. Rules for treatment with immunomodulators]

At present treatment of multiple sclerosis (EM) is a challenge for neurologists in general and specialists in EM in particular, who have the problem of digesting the avalanche of information they receive. Use of immuno modulators has shown that it is possible to change the natural course of the disease and improve life expectancy in EM. Both the number of exacerbations of EM and the overall improvement benefit from such treatment. Immunomodulators have an established place in the treatment of the remitting relapsing form, although its efficacy seems to become less when it is used at more advanced stages of EM and seems to have been ruled out for progressive primary forms. Immunomodulators may be useful during initial stages of the disorder in the first episodes before a definite diagnosis has been established, although it is obvious that markers for prognosis are still needed. MR and cerebrospinal fluid studies may be useful for this.

Patient selection is essential to obtain good results. Although it is not fully established, it seems that early use of high doses improves long term control of the disease.