<prompt> Which is given to prevent relapse in multiple sclerosis?IFN-betaCyclosporineCorticosteroidsI FIN-gamma  <response>: Ans: a IFN-beta Ref: Harrison, 16th ed, p. 2467; Davidson, 20th ed, p. 1216Multiple sclerosis is characertised by a triad of inflammation, demylination and gliosis; the course can be relapsing - remitting or progressive.MS is twice more common in females. MS risk correlates with high socioeconomic status. High antibody titres against many viruses have been reported in serum and CSF of MS patients, including measles, herpes simplex, varicella, rubella, Epstein - Barr, and influenza C and some parainfluenza strains.Sensory loss is most common initial symptom followed by optic neuritis.MRI is the investigation of choice. Dawsons fingers corresponds to perivenous demylination seen in MRI in multiple sclerosisFour clinical types of MS are there.The relapsing remitting type accounts for 85 of cases.DISEASE-MODIFYING TREATMENTS IN MSTreatmentMode of actionCommentInterferon betaImmune modulationIn widespread use for reducing relapse rateGlatiramer acetateImmune modulationSimilar efficacy to interferon betaAzathioprineImmune suppressionSimilar efficacy to interferon betaCyclophosphamideImmune suppressioncytotoxicOccasionally used in aggressive disease.Not recommended for widespread use no proven benefit in RCTsMitoxantroneImmune suppressioncytotoxicEarly trials in aggressive disease no proven benefit in RCTsPlasmapheresisImmune modulationOccasionally used in aggressive disease no proven efficacy in RCTsIntravenous immunoglobulinImmune modulationOccasionally used in aggressive diseaseMonoclonal antibodies to beta-integrinse.g. natalizumabImmune modulationlymphocyte entry into CNSEncouraging experimental results no proven efficacy in RCTsMonoclonal antibodies to lymphocyte epitopes e.g. campathl-HImmune suppressionlymphocyte depletionEncouraging experimental results no proven efficacy in RCTs 