As noted in an earlier chapter, starting treatment early is one of the most important factors in managing MS. Researchers have discovered that the disease process may begin well before any obvious symptoms arise, allowing damage to occur in the brain and spinal cord. The earlier you begin treatment, the better your chances of minimizing nerve damage and halting progression.

Since many people who are diagnosed with MS have relapsing-remitting disease, they often question whether starting one of the disease-modifying therapies (DMTs) immediately is right for them. They may be feeling good at the moment and have their symptoms under control. They may also hesitate to begin treatment because it is a long-term commitment that must be monitored by a health care provider; it has an impact on their lives. However, evidence supports the need for early treatment:

• Experts agree that damage to the CNS occurs very early in the disease process, even before symptoms appear.

• Treatments may shorten the length and decrease the severity of exacerbations.

• Treatments may also modify the disease course, slowing the advance of MS.

• Treatments can extend remissions, or the period of time between exacerbations.

The goal of treatment, then, is to slow irreversible damage by preventing the inflammatory process that can lead to demyelination and axon damage. Therapy generally isn't a cure, but it's a good line of defense in helping you to stay as healthy as possible for as long as possible.