Dear MSQR Readers

Most persons living with multiple sclerosis (MS) will experience a relapse (attack or exacerbation) at least once. Over 73% of our NARCOMS registrants report having had a relapse while another 7% are not sure. ?Acute Multiple Sclerosis Relapses? has been the focus of a recent consensus conference hosted by our parent organization the Consortium of Multiple Sclerosis Centers (CMSC). The objectives of this consensus conference were to define the clinical, MRI, and immunologic characteristics of relapses in MS as well as to identify practice patterns for treatment of relapses and to define treatment response. Many relapses are serious enough to require treatment with high dose steroids. With my friend and partner Timothy L. Vollmer, MD, I have authored an understandable (hopefully) explanation of why we use steroids for acute attacks. Other therapies are also reviewed. Our goal was for you to gain an understanding of the rationale and mechanism of action of high dose steroids as we currently understand them, and thus be better prepared for the next time they may be
needed in your or a loved one?s situation.

The loss of nerve cells and their axons in MS have been appreciated for over 100 years. There are now many studies that have effectively emphasized this degenerative process. Therefore, MS can be considered not only a ?demyelinating? disease, but also a degenerative one, with this nerve cell/axon loss likely responsible for the progressive neurologic disability evident in many. Practical issues surrounding progression in MS is the focus of Elizabeth Auld?s article. It brings to the forefront practical suggestions for staying as healthy as possible in spite of progression.

As always I would like to thank our colleagues at United Spinal Association who make this publication possible through our partnership. Also, Dr. Tuula Tyry, our Program Manager, is truly the driving force behind the growth and successes of this database. At her side is Ms. Nancy Silingo and Ms. Patricia Davis, whose talents are essential to running the database. My sincere thanks go to each of them for their hard work and dedication to this project.

Happy Holidays to ALL,

Denise I. Campagnolo, MD, MS