[Multiple sclerosis: diagnostic procedures and current therapeutic developments].
The diagnosis of multiple sclerosis remains a clinical one. It is based on the documentation of lesions at two or more sites of the CNS and of two or more relapses in relapsing-remitting disease, or persistent deterioration for 6 months in primarily chronic-progressive disease. Because no symptom and no result of a paraclinical investigation is specific enough, a careful differential diagnostic work up by a physician competent in clinical neurology is essential. CSF examination, blood serology, MRI and in some cases evoked potentials may help in this work-up. The results of recently completed controlled trials suggest that, besides high dose steroid treatment of acute relapses, immunomodulatory treatments may help to improve the prognosis in relapsing-remitting phase of the disease. Treatments that will enter clinical practice in the next year or two are recombinant interferon beta-1b and -1a and perhaps copolymer 1. Non-selective immunosuppressants (azathioprine, in more severe cases other substances with more intensive cytostatic activity) also have a place in selected cases. The efficacy of such treatment in secondary chronic-progressive disease as well as the indication for very early treatment are now under investigation. Some possible future developments in diagnosis and therapy of MS are discussed.
Kappos
L
L
Neurologische Universitätsklinik, Kantonsspital Basel.
D001921:Brain / Q000473:pathology; D003937:Diagnosis, Differential; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016899:Interferon-beta / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000628:therapy*; D011241:Prednisone / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016899:Interferon-beta; D011241:Prednisone