Chapter 36 - New treatments for multiple sclerosis

Abstract

This chapter presents an overview of new treatments for multiple sclerosis (MS). MS is a disease of the central nervous system (CNS) in which the demyelination and synthesis of immunoglobulin are, respectively, the most characteristic morphological and biochemical abnormalities. The disorder generally runs a very chronic and relapsing course and in regions of high prevalence, MS rivals stroke and trauma as a cause of neurological disability. Evoked-response techniques, employed to measure conduction in CNS pathways, can aid the diagnosis of MS by providing evidence of subclinical abnormalities. A biochemical study of CSF proteins in MS has been refined with the widespread use of IgG ratio and the index determinations and recognition of the significance of oligoclonal patterns of CSF IgG on electrophoresis. Computed tomography (CT) and related brain-scanning methods, including nuclear-magnetic resonance (NMR), can be used to detect cerebral abnormalities in MS and to follow the course of the disease. Improved methods for assessing disease activity and progression in MS, for example refined disability scales, measurement of evoked potentials, CT and NMR scanning, and helper/suppressor T cell ratios in peripheral blood, have stimulated interest in controlled clinical trials to derive direct information about the disease process and to test hypotheses based on experimental data.