RT Journal Article SR Electronic T1 Predicting and preventing the future: actively managing multiple sclerosis JF Practical Neurology JO Pract Neurol FD BMJ Publishing Group Ltd SP 133 OP 143 DO 10.1136/jnnp.2009.177212 VO 9 IS 3 A1 M Hutchinson YR 2009 UL http://pn.bmj.com/content/9/3/133.abstract AB 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 recommendations 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.