The application of imaging methods in assessing disease activity in patients with multiple sclerosis (MS) is beginning to influence strategies for treatment. Meanwhile, most clinicians treat patients with severe disability symptomatically, reserving experimental therapies aimed at modifying the long-term course for those in whom disability is accumulating and leaving mild cases untreated. Although corticosteroids have an established role in the treatment of MS in relapse, it is not clear how the balance between beneficial and adverse effects can best be achieved. Enthusiasts now claim that high-dose intravenously administered methylprednisolone is more effective, less complicated, benefits a wider range of patients, and has more than just an anti-inflammatory effect on the disease process; many clinicians are now switching to this regimen as the preferred means of administering corticosteroids to patients with MS.
Following the initial report of clinical improvement in five of seven patients with acute demyelination,1 open comparisons showed