The current approaches to therapy are becoming much more focused on the specific mechanisms thought to be important in the disease, as research teaches more about the complex phenomena involved in the disease.

It was noted by the earliest observers of MS that inflammatory lesions caused local patches of demyelination. When corticosteroids were discovered, their remarkable anti-inflammatory activity was used in MS for acute attacks of the disease. It is now clear that steroids in high doses, usually given intravenously, can reduce inflammation and shorten the attack of symptoms, but they probably do not have more than a short-term benefit. Early observers realised that something more than a drug to reduce inflammation was necessary. When it became clear that an immunological reaction was how the demyelination occurred, general agents that could stimulate or suppress the immune system were tried, but they also had little effect and had many side-effects. Over the years the complexity of the immune reaction was better understood, and now agents that target various steps are being developed and tested. This explains why so much basic research needs to be done before an effective drug is available. It is possible, but less likely, that very effective therapy will become available before we understand the disease better through basic research into the amazing ways the nervous system reacts, responds, heals, and fails under the influences of disease. There is an increasing sense of hope in patients, their physicians, and researchers, because of the increasing research effort and the large number of studies currently underway. Also the community of investigators dedicated to MS research has never been so great and it increases each year.

Since the 1970s, neurologists have been able to modify the acute attacks of the disease, but they have also searched for agents that would modify the eventual outcome of MS. In the last two decades a number of agents have been tested, and for the first time show evidence that they can modify the number and severity of the attacks of MS and reduce the activity seen on MRI. There is now information from additional studies that the reduction in acute attacks and suppression of inflammation on the MRI by these agents does result in a reduction in progression of the disease and disability in later years.

An exciting development has been the observation that there are at least four patterns of reaction involved in the areas of myelin and axon damage. This may lead to different focused therapeutic interventions, depending on the pattern of neurological damage, but will involve finding practical ways to identify the patterns in a patient, especially early in the disease. The challenges are great, but there is hope that in the over 100 clinical trials, the over 30 different agents being studied, and the 14 combination studies being conducted that substantial benefits will continue to come to the many who currently suffer from MS.