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Introduction - 2nd Dubrovnik International Conference on Multiple Sclerosis

The past several years have seen a change of emphasis in the meetings devoted to multiple sclerosis (MS) due to the exciting new developments in the long-term treatment of the disease, giving hope to patients, and new therapeutic tools to their neurologists. Nevertheless, many questions remain regarding the exact pathogenesis and etiological factors of the disease. The matter of MS as a single disease, possibly with different pathogenetic mechanisms and/or different phenotypic expressions, or separate disease entities with diverse genetic characteristics, is still unsettled, as is the nosological situation of the eponymic variants of MS, Marburg’ s, Schilder’ s, Balo’ s and Devic’ s diseases. It is abundantly clear that all recurrent demyelinating conditions are not always MS, so that alternative diagnoses must be considered before initiating immunomodulatory or other forms of long-term treatment. Other important questions that remain unanswered are: will it ever be possible to identify families at risk for the disease by means of MRI and/or sophisticated genetic testing? Is there evidence that a pre-disease condition, the “ MS trait” exists and would its identification be the long-sought means for preventing the development of the disease? Discussions of immunomodulatory and other forms of long term treatment are not only understandable, but also most desirable, since a consensus has not yet been reached regarding many of its aspects, such as choice of specific agents, single versus multiple drugs, and optimum dosage and route of administration. An objective critique of the methodology of therapeutic trials should help treating neurologists better appreciate the impact of the available drugs and those still under investigation. The cost of many of these medications remains very high, adding to the already heavy financial burden of the disease itself on health care systems. Not every neurologist believes that all patients with MS should receive one of the available treatments, and a more thorough understanding of the natural history of the disease may prove critical in choosing the right patient for the right drug, or none at all. Some of these issues were addressed during the First International Dubrovnik Conference on MS in May 2001, and will again be examined with the added experience of two more years. We believe that these unresolved questions were sufficient reasons for convening this Second International Dubrovnik Conference on Multiple Sclerosis and inviting distinguished experts from Canada, Croatia, France, Germany, Israel, Poland, Spain, Switzerland, the United Kingdom and the USA to give us the benefit of their knowledge and wisdom.

multiple sclerosis; etiology; treatment; meeting

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