Multiple sclerosis is a chronic and often disabling disease of the nervous system, affecting about 1 million people worldwide. Even though it has been known for over a hundred years, no cause or cure has yet been discovered-but now there is hope. New therapies have been shown to slow the disease progress in some patients, and the pace of discoveries about the cellular machinery of the brain and spinal cord has accelerated.

This book presents a comprehensive overview of multiple sclerosis today, as researchers seek to understand its processes, develop therapies that will slow or halt the disease and perhaps repair damage, offer relief for specific symptoms, and improve the abilities of MS patients to function in their daily lives.

The panel reviews existing knowledge and identifies key research questions, focusing on:

• Research strategies that have the greatest potential to understand the bio- logical mechanisms of recovery and to translate findings into specific strategies for therapy.
• How people adapt to MS and the research needed to improve the lives of people with MS.
• Management of disease symptoms (cognitive impairment, depression, spasticity, vision problems, and others).

The committee also discusses ways to build and financially support the MS research enterprise, including a look at challenges inherent in designing clinical trials. This book will be important to MS researchers, research funders, health care advocates for MS research and treatment, and interested patients and their families.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON MULTIPLE SCLEROSIS: CURRENT STATUS AND STRATEGIES FOR THE FUTURE
• BOARD ON NEUROSCIENCE AND BEHAVIORAL HEALTH
• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • THE U.S. NATIONAL MULTIPLE SCLEROSIS SOCIETY
  • RECENT ADVANCES IN MS
  • ORIGIN OF THE STUDY
  • PREVIOUS REVIEWS OF MS RESEARCH PROGRAMS
  • THE IOM COMMITTEE AND ITS MANDATE
  • HOW THE COMMITTEE CARRIED OUT ITS TASK
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Clinical and Biological Features
  • THE CLINICAL PICTURE: SYMPTOMS, DISEASE COURSE, VARIATION, AND DIAGNOSIS
  • UNDERLYING DISEASE MECHANISMS
  • ANIMAL MODELS OF MS
  • REFERENCES
• 3. Characteristics and Management of Major Symptoms
  • COGNITIVE IMPAIRMENT
  • DEPRESSION
  • SPASTICITY AND WEAKNESS
  • ATAXIA AND TREMOR
  • BLADDER AND BOWEL DYSFUNCTION
  • VISUAL DISTURBANCES
  • FATIGUE
  • SEXUAL DYSFUNCTION
  • PAIN
  • REFERENCES
• 4. Disease Management and Measurement
  • LIVING WITH MS
  • MEASURING FUNCTIONAL STATUS AND QUALITY OF LIFE
  • ASSISTANCE
  • INFORMATION AND COMMUNICATION
  • HEALTH CARE
  • REFERENCES
• 5. Strategies for Future Research on Disease Mechanisms
  • NEUROBIOLOGY
  • IMMUNOLOGY
  • IDENTIFICATION OF INFECTIOUS AGENTS IN MS
  • IDENTIFICATION OF DISEASE SUBTYPES
  • TECHNOLOGIES AND RESEARCH STRATEGIES
  • REFERENCES
• 6. Future Strategies for MS Therapies
  • STRATEGIES FOR DISEASE MODIFICATION
  • CHALLENGES IN MS CLINICAL TRIALS
  • SHARED RESOURCES
  • REFERENCES
• 7. Building and Supporting the Research Enterprise
  • RESEARCH FUNDING
  • HUMAN RESOURCES
  • INFRASTRUCTURE
  • CLINICAL TRIALS
  • BIOTECHNOLOGY AND PHARMACEUTICAL FIRMS
  • HEALTH CARE RESEARCH
  • ROLE OF VOLUNTARY HEALTH ORGANIZATIONS
  • REFERENCES
• 8. Recommendations
  • ETIOLOGY AND PATHOGENESIS
  • TOOLS FOR RESEARCH AND DIAGNOSIS
  • THERAPEUTICS
  • HEALTH STATUS AND QUALITY OF LIFE
  • RESEARCH ENTERPRISE
  • REFERENCES
• Appendixes
  • Appendix A Committee and Staff Biographies
  • Appendix B List of Expert Consultants
  • Appendix C Workshop Agendas
  • Appendix D Kurtzke's Expanded Disability Status Scale (EDSS)
  • Appendix E Drugs Used in the Treatment of MS
  • Appendix F U.S. Social Security Administration's Criteria for Qualifying as Disabled from MS
  • Appendix G Treatments That Have Been Claimed to Be of Benefit in MS

Support for this project was provided by the National Multiple Sclerosis Society. The views presented in this report are those of the Institute of Medicine Committee on Multiple Sclerosis: Current Status and Strategies for the Future and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.