ABSTRACT
Multiple sclerosis (MS) patients most commonly present when the anatomic and clinical burden of disease is limited. We therefore have a unique opportunity to substantially influence the natural history of this disabling disease if effective disease-modifying strategies can be implemented early. Upon achieving success in limiting disease progression, the entire landscape of what consti tutes MS will be dramatically altered over the next few decades. MS has traditionally been viewed as an enigmatic, untreatable, and almost uniformly disabling neurological disease. However, remarkable progress has been achieved over the past few years in identifying disease modifying therapies that can favorably influence the disease process in MS. Furthermore, new insights into the underlying disease mechanisms that culminate in inflammatory demyelination has yielded a number of novel therapeutic strat egies. Powerfully persuasive evidence is now available to confirm the premise that the disease process in MS is constitutive, even in early-stage patients who appear to be well. Neuropathological and brain imaging data, coupled with our inability to predict the clinical course in individ ual patients, supports the notion of early treat ment for all patients.
