Future options for therapies to limit damage and enhance recovery

Advances in understanding the pathogenesis of multiple sclerosis have already identified treatments that modestly modify the course of the disease. Future efforts will depend increasingly on how well we apply the insights of therapeutic immunology to the inhibition of the sequence of events which generates an inflammatory process within the central nervous system and targets this to myelinated axons, The timing and choice of treatments will be increasingly determined by correlations between the sequence of events that leads to inflammation, demyelination and axon degeneration and the clinical course of the disease. Successful limitation of the disease processes may have the unexpected dividend of also promoting repair of intact axons; but, if not, parallel efforts will have to be directed at remyelination through applied neurobiology and it makes sense to explore strategies for both limiting and repairing the damage.