[New challenges in multiple sclerosis]

After decades of prevailing fatalism concerning multiple sclerosis new hopes emerge at the horizon of both the diagnostic and therapeutic section catalyzed by a new understanding of the neurodegenerative disease process. The rapidly evolving MRI techniques enabled an analysis of CNS tissue injury in terms of structure and chemical composition. Based on studies with serial MRI scans, multiple sclerosis is increasingly considered as a dynamic disease process, in which not only the myelin but also the axons are damaged already in a very early stage. The introduction of interferon therapy caused much attention and great hope both among patients and clinicians. Unfortunately clinical studies require a large number of patients and long periods. Obviously if treated early enough and consistently, patients with the relapsing-remitting form of multiple sclerosis suffer less exacerbations, MRI lesions and disease progression in comparison to patients not treated by interferons. But sustained improvement in terms of extramortality and extramorbidity can only be expected in the medium term.