Abstract
Multiple sclerosis is an inflammatory process in the central nervous system involving autoimmune mechanisms, manifesting as neurodegenerative consequences associated with significant losses in both the white and grey matter. A therapeutic intervention targeting the inflammatory process with corticosteroids must be rapid, administered at the time of acute exacerbation, but it is also necessary to start long-term immunomodulation therapy as soon as possible after the diagnosis.
Unless the effect on the actitivity of the disorder, measured by the annual number of acute relapses, is sufficciently effective, administration of the basic therapeutic agents (interferon-ß, galtiramer acetate) must be escaletd as soon as possible. The golden standard is the monoclonal antibody natalizumab.
It is currently possible to determine the risk of progressive multifocal leukoencephalopathy for individual patients associated with this therapy; in patients at risk careful and continuous monitoring is recommended. Also, it is worth mentioning that several novel agents, especially those administered orally, of which fingolimod has already been approved in the EU and is already used in the neighbouring countries, provide higher efficacy that the original drugs interferon-ß and glatiramer acetate, though the latter admittedly are rather safe.
In more advanced stages of the disease, most immunomodulants are of very limited efficacy, and the quality of life of the patients can only be influenced by well-balanced symptomatic therapy.