The inflammatory pathology of MS includes damage to the myelin and axon in the white matter of the brain and spinal cord.¹ Recently, there have been reports of grey matter involvement resulting from different pathological mechanisms that have been shown to contribute to longterm disability in MS.² There are implications of MS that involve not only the symptoms but also the adjustment of living with a chronic illness that may bring disability, lifestyle changes and significant alterations in quality of life. With the advent of disease-modifying therapy, patients with relapsing forms of MS must follow treatment regimens, monitor their condition, adapt to changes and regularly make decisions about whether they need to seek care or are able to handle their problem on their own. Functioning as a self-care manager requires a high level of knowledge, skill and confidence.

The History of Disease Modification in Multiple Sclerosis
In the 20th century, treatment focused on symptomatic care, as well as relapse management. The use of corticosteroids was the hallmark of relapse management, although there was no evidence that this therapy brought any long-term permanent benefit. During the 1980s, researchers began studying interferons as a possible treatment for people with MS because it was believed that intercurrent viral infections may trigger MS attacks and beta-interferons might have an immunomodulating effect on this process.³ During the same period there were investigations into the use of a synthetic polypeptide, co-polymer I, to modify MS relapses. As a result of four pivotal trials that demonstrated effective outcomes in relapsing forms of MS, Betaseron was approved for use in the US in 1993; Avonex and Copaxone entered the marketplace for relapsing–remitting MS in 1996; and Rebif, although approved in many countries throughout the world, finally entered the US market in 2002.