The Neurologist's Perspective: What Do We Know and Where Do We Go?

The neurology panel reviewed the natural history of multiple sclerosis, therapy of acute exacerbations and chronic progressive disease, outcome measurement, and sexual dysfunction. A survey conducted among neurologists, both MS specialists and generalists, revealed widespread use of high dose pulse methylprednisolone therapy, prevalent use of oral corticosteroids, and anticipated acceptance of interferon 1 beta therapy. Studies confirm that MS is usually a progressive disease, with half of patients requiring gait assistance within fifteen years of onset, but the illness shortens mean life expectancy by only six to seven years. High dose intravenous corticosteroids or ACTH hasten recovery from acute attacks, but the effect of oral corticosteroids in moderate doses has been called into question by recent trials in isolated optic neuritis. In these studies, patients treated with oral prednisone had a higher frequency of relapse and a higher rate of conversion to clinical MS than did patients treated with high dose methylprednisolone. Improved outcome measurements are needed, as existing clinical scales have many deficiencies. Magnetic resonance imaging will probably find expanding use in clinical trials. At the "What Do We Know?" conference, preliminary plans were formulated to establish a research consortium, tentatively called the North American Research Consortium on Multiple Sclerosis (NARCOMS), to investigate clinical issues in MS. Despite evidence that sexual dysfunction is prevalent in MS, specific data, especially of a prospective nature, are insufficient. Therefore, the neurology panel proposed the development of an instrument to evaluate sexual function in MS longitudinally.