MS and clinical studies

Most patients (85-90%) experience a relapsing-remitting (RRMS) course with repeated episodes of CNS-dysfunction, followed by partial or fully remissions. Nevertheless, if not effectively treated, accumulating disability will usually appear along the disease course, and a substantial proportion of the patients will convert to a secondary progressive course (SPMS). The most disabling disease course, primary progressive MS (PPMS), affects about 10-15 % with gradually increasing disability without remission.

Although several genetic and environmental risk factors of MS are identified, the exact pathogenesis of the disease is not yet fully understood. No cure for MS is available, but acute relapses are shortened by courses of high dose methylprednisolone. Increasing numbers of disease-modifying therapies reduce the relapse-frequency and disability progression, most effectively in the early inflammatory phase of the disease. With the development of more effective treatments, the aim of treatment has changed dramatically during the last decades, from simply reducing relapse rates and slowing of disability progression to preventing all evidence of new disease activity.

Early initiation of highly effective therapy may be one way to avoid permanent disability in relapsing MS. Careful risk stratification among the increasing numbers of treatment options, minimize the risk of serious side effects associated to the highly effective drugs. The aim should therefore be that most patients receive the most effective therapy option from onset of the disease.

Tailored symptomatic therapy and rehabilitation to reduce potential disabling symptoms such as spasticity, pain, bladder and bowel dysfunction, depression and improve overall functioning are important as well.