Multiple sclerosis: Why do we understand so little and are unable to provide meaningful therapy?

Objectives: Despite many years of intensive research, multiple sclerosis (MS) still evades understanding and its treatment remains suboptimal. Our aim in this report is to analyze the reasons for this situation, review the present available therapies and put forward several constructive suggestions. Methodology: We searched the literature from 1966 to 2005 for relevant articles and chapters. Review articles were also included. Results: Reasons for the current satelment in the field are the meaninglessly broad spectrum of diagnostic criteria, the inability to define the efficacy of therapies, lack of fulfillment of criteria for an autoimmune condition and the pressure from the biomedical industry. Conclusions: Clinical criteria for diagnosis should be redefined and the new set of disease classification should be based on disease course; clinical studies should consist of homogenous group of patients and a uniform set of end points to evaluate clinical therapeutic trials should be agreed upon. Most important, a moratorium on the autoimmunity hypothesis in MS will enable to redirect funds for research with lower emphasis on autoimmunity, but rather on novel approaches to the problem.