THERAPEUTICS OF MULTIPLE-SCLEROSIS

The treatment of MS is far from satisfactory. Patients and their families should be provided with a chance to learn about the illness and their emotional and social needs should be addressed by knowledgeeable and supportive staff e.g., neurologists, psychologists, psychiatrists, social workers, physiotherapists, occupational therapists, and dieticians). Patients who are in remission should be encouraged to enjoy an active life, and to seek prompt medical attention and rest if they develop symptoms of an infection. They should contact their physician at times of apparent disease activity so that intercurrent infections can be properly identified and treated and so that ACTH or corticosteroids can be started if warranted. Currently, there appears to be little evidence that immunosuppressive drugs significantly affect the natural history of the disease. These agents should be administered only in the setting of controlled clinical trials by physicians experienced with their use. Whenever possible, patients with progressive disease should be offered a chance to participate in controlled clinical trials. Failing this, corticosteroids can be tried and repeated in patients who seem to benefit but prolonged steroid use should be avoided. Most of the complications of MS can be managed with some success. While we await a better understanding of the factors that contribute to disease activity, both definitive treatment and treatment of complications will continue to be directed by the results of carefully designed and properly controlled, randomized clinical trials.