Rev Neurol 2002 Aug 1;35(3):221-7
Alvarez Cerme o JC.
Hospital Ramon y Cajal. Facultad de Medicina, Madrid, Espa a.
INTRODUCTION AND METHOD.
There is no curative treatment for multiple sclerosis (MS) nor are there precise data that enable us to ensure a patient is given an accurate prognosis of his or her illness.
A small percentage of patients will have such a particularly benign course that they will not require preventative treatment for the attacks.
Unfortunately, many of them, above all those that display high lesion loads in the magnetic resonance imaging (MRI), will develop a relapsing remitting illness that will leave permanent sequelae.
The initial inflammatory phases of MS are essential since they establish an accumulation of axonal lesion that will mark the future of a possible, more or less serious, neurodegenerative phase and which will become manifest in the second progressive phase.
Until now, useful treatment in MS has acted on the inflammation, and efficiency is low in the later stages.
For this reason, some authors recommend that IFN b 1a IM must be initiated in patients after the first attack, now that its use has recently been approved in the European Union in these cases.
We believe that each patient should be informed and treatment proposed following the first demyelinating attack, provided he or she meets the criteria needed to be considered as having a high risk of developing MS, such as having a high lesion load in MRI.