REVIEW

preventing the future: actively managing multiple sclerosis Michael Hutchinson Relapsing-remitting multiple sclerosis (MS) has a highly variable clinical course but a number of demographic, clinical and MRI features can guide the clinician in the assessment of disease activity and likely disability outcome. It is also clear that the inflammatory activity in the first five years of relapsing-remitting MS results in the neurodegenerative changes seen in secondary progressive MS 10–15 years later. While conventional first-line disease modifying therapy has an effect on relapses, about one third of patients have a suboptimal response to treatment. With the advent of highly active second-line therapies with their evident marked suppression of inflammation, the clinician now has the tools to manage the course of relapsing-remitting MS more effectively. The development of treatment optimisation recommenda-tions based on the clinical response to first-line therapies can guide the neurologist in more active management of the early course of relapsing-remitting MS, with the aim of preventing both acute inflammatory axonal injury and the neurodegenerative process which leads to secondary progressive MS. P rediction is a risky business in any walk of life. While natural history studies of cohorts of multiple sclero-sis (MS) patients have outlined a number of factors associated with a good (benign) prognosis, or a more aggressive course, it is often difficult to apply them to the individual patient in the clinic. The course of the disease is highly variable between patients; even after 10 years of illness i