ABSTRACT
Large scale multicenter controlled clinical trials have now virtually transformed medical research and clinical medicine. In neurology they have had indelible effects in epilepsy, stroke, and multiple sclerosis (MS). They seem to be the accepted path to future progress in these areas as well as with even more intractable illnesses such as amyo trophic lateral sclerosis. So profound and perva sive is the influence of these trials that they now routinely extend themselves into the offices of small group and solo practices, where many clini cians have redefined their endeavors as private research institutes. In the field of MS, increasing numbers of phase 3 and phase 4 treatment trials are expected to look not just at relapsingremitting MS and secondary progressive MS, but also at disease prevention. Trials of new treat ments for suppression of acute exacerbations, specific symptom management, and functional recovery can also be safely predicted.
