Abstract
Multiple sclerosis is an inflammatory autoimmune primary demyelinating disease which affects central nervous system. Pathophysiology of multiple sclerosis is based on two main processes - inflammation and degeneration.
At the begging the inflammatory part plays the main role but as the disease progresses neurodegenerative processes begin to dominate. Axonal loss causing brain atrophy is the main reason for patients' disability.
Since all the currently accessible immunomodulatory drugs are aimed to suppress the inflammation it is necessary to start the treatment as soon as possible. The best is to begin when only clinical isolated syndrome is present or in early stage of multiple sclerosis.
It is already known that almost two thirds of patients treated with first line therapy (interferon beta or glatiramer acetate) show only suboptimal response to the treatment in first two years. In this group of patients an alternative therapy should be considered and switched to immediately.
Timing of the escalation is crucial. The sooner it is done the higher chance we must prevent early progression of the disease.
This applies particularly to patients with bad prognosis of the disease and they profit form early escalation to second line therapy the most. Regular screening of disease activity and treatment effects is therefore necessary.
It is recommended to do so every 3 months in the first year and every 6 months afterwards. Brain magnetic resonance imaging is indicated every 6 months in the first year and then at least once a year.
Patients with spinal symptoms should have MRI of the spine at least once a year.