Evidence for an Early Treatment of Multiple Sclerosis

  • G. Comi
  • L. Moiola
Part of the Topics in Neuroscience book series (TOPNEURO)


Multiple sclerosis (MS) is a disease leading to a significant disability in the vast majority of patients [1, 2]. The available immunomodulatory treatments are not a cure for MS, but there is clear evidence from class I clinical trials that they significantly reduce the disease activity and delay the increase of disability in relapsing-remitting patients [3-10]. However, the positive effects are less clear in secondary progressive patients [11, 12]. The different effects of immunomodulatory treatments according to the disease course is probably explained by the complex pathogenesis of MS. Indications on the use of available therapies for MS have substantially changed in a few years, passing from a conservative [13, 14] to a more-aggressive attitude [15]. It is interesting to note that the consensus statement of the Canadian MS Clinic Network, recently published [15], on the use of disease modifying agents in MS, requires evidence of ongoing disease activity, which can be based on clinical or magnetic resonance imaging (MRI) data. The previous consensus of treatment [13, 14, 16, 17] required two or more relapses in the last 2 years in order to start treatment. These changes are probably explained by the results of the new trials testing the efficacy and safety of inter-ferons and glatiramer acetate [5-7, 10], by the experience acquired during these years, and by the recent knowledge of the pathophysiology of the disease. The demonstration of early irreversible axonal damage is a strong argument in favor of early treatment, an option that is beginning to be favored by many neurologists [18, 19].


Multiple Sclerosis Optic Neuritis Glatiramer Acetate Magnetization Transfer Imaging Tiple Sclerosis 
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© Springer-Verlag Italia 2004

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  • G. Comi
  • L. Moiola

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