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QJM Advance Access originally published online on April 8, 2005
QJM 2005 98(5):373-378; doi:10.1093/qjmed/hci059
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Commentary

Treatment of multiple sclerosis: beyond the NICE guidelines

A. Chaudhuri and P.O. Behan

From the University of Glasgow, Glasgow, UK

Address correspondence to Dr A. Chaudhuri, Department of Neurology, Institute of Neurological Sciences, 1345 Govan Road, Glasgow G51 4TF. email: ac54p{at}udcf.gla.ac.uk

Multiple sclerosis (MS) is a common, disabling neurological condition whose pathogenesis is not clearly understood. Although current treatment recommendations assume an immunopathogenic disease mechanism, MS may not be an autoimmune disorder. Long-term immunological therapy for MS is in our view an untested approach, guided by uncritical acceptance of data from drug trials. We do not believe that there is convincing evidence that any of these immune-based treatments prevents long-term disease progression, or has much effect on common disabilities such as fatigue, pain, depression and cognitive impairment. The recent recommendations of the National Institute of Clinical Excellence did not address important issues regarding disease modification, management of paroxysmal symptoms and the likely therapeutic candidates for future treatment trials. We discuss treatment options for MS beyond the NICE guidelines.


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A. Chaudhuri
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