Since publication of the fifth edition of Multiple Sclerosis: The Guide to Treatment and Management in 2001, the ability to better understand relevant disease mechanisms as well as to modify the course of the disease has had a profound impact on the outlook of people with multiple sclerosis (MS). There are more grounds for hope now than four years ago, although we must also recognize that in our attempts to advance the art of medicine unexpected complications can occur.

Improvements have also been achieved in symptomatic management and neurologic rehabilitation. New drugs have been developed, and more effective ways of administering older drugs devised. Controlled trials of certain aspects of neurorehabilitation have shown that there are many effective approaches to management of MS.

This book provides a comprehensive, readily accessible guide to the wide diversity of therapeutic options now available to treat MS. As with previous editions, all therapies in current use are discussed in detail and a statement given for each that reflects consensus opinion about each therapy’s usefulness and effectiveness.

In deciding whether to adopt a particular form of treatment (whether it be medical, surgical, rehabilitative, or “alternative”), it is necessary to weigh the evidence about its effectiveness and the risk and nature of side effects for the individual patient. We have done that in this book to the best of our ability, trying to provide a general recommendation. Wherever possible we have based our recommendations on scientific, peer-reviewed publications.

Readers of the previous editions will notice that we have added a guide to further reading for additional details about particular treatments and how their effectiveness and side effects have been assessed. Summaries or abstracts of the journal articles cited in this book may be found through “Medline” searches, available through the website of the National Library of Medicine (www.hlm.nih.gov); entire articles may be obtained from medical libraries.

As today the Internet is the first place to which many people turn for information the contents of this book are available on the Multiple Sclerosis International Federation (MSIF) Web site, “The World of MS” (www.msif.org). The online version allows for rapid updating of material between print editions, and we urge readers to use this resource to access newly available information.

All material included in this volume was reviewed by members of the International Medical & Scientific Board (IMSB) of MSIF, all of whom are neurologists in active practice who treat patients with MS on a daily basis; the authors thank them for their many suggestions and comments. Their opinions are based not only on published data but also on their daily experiences and information from trusted colleagues. We give special thanks to the Multiple Sclerosis International Federation, the official sponsor of this volume, for facilitating publication of this sixth edition.