Controversies in Neurology
April 2006

Early Multiple SclerosisTo Treat or Not to Treat?

Author Affiliations

Author Affiliation: Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC.




Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Neurol. 2006;63(4):619. doi:10.1001/archneur.63.4.619

The truth is rarely pure and never simple.—Oscar Wilde

We are fortunate to now have several effective treatments for multiple sclerosis (MS), and it seems intuitive that such a serious neurological disorder should be treated. Glatiramer acetate, interferon beta-1b and -1a, and mitoxantrone hydrochloride have demonstrated efficacy for relapsing-remitting MS. None of these agents is effective in every individual, and like all medications, these drugs can have adverse effects. While indefinite treatment is no doubt a better option than progressive neurological deterioration, do we know that MS is so uniformly bad that every single individual who has it must be treated immediately and indefinitely? More to the point, do we have the luxury of deferring therapy in select individuals long enough to determine which patients, if any, could reasonably avoid long-term medication?

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