Chapter 22 Treatment of Progressive Multiple Sclerosis

Abstract

This chapter describes treatment of progressive multiple sclerosis (MS). The onset of the progressive phase of MS is regarded by many as the main determinant of the onset and development of irrevocably increasing disability. Theoretically, one of the main objectives of treating patients with the relapsing-remitting form of the disease is to prevent or, more realistically, to delay the onset of the progressive phase. For the majority of patients, the development of progressive MS follows an initially relapsing-remitting course and is therefore termed “secondary progressive MS (SPMS).” The fundamental issue in progressive MS is determining the pathological substrates that underlie the clinical changes, for it is only by understanding these processes that appropriate and effective treatments can be arrived at. Although inflammation is considered to be a key process, if not the key process in relapsing-remittingMS (RRMS), the transition from RRMS into SPMS is thought to relate to a large extent to axonal loss; the popular theory at present is that although axonal loss occurs from the earliest stage of the condition, at a certain point a threshold is reached, beyond which any further loss will result in clinical worsening or progression.