The treatment of relapsing multiple sclerosis (MS) remains a rare beacon of success in the long campaign against neurological disease. The ready availability of a phase II clinical outcome (eg, gadolinium-enhancing lesion) that tracks a relevant phase III clinical outcome (eg, annualized relapse rate) is one of the major reasons for this success. Eight therapies have been approved by the US Food and Drug Administration in less than 20 years, and 3 more are under current consideration at the Food and Drug Administration following successful phase III clinical programs. However, before feeling triumphant, we must recognize that our current therapies ...

A previously healthy 40-year-old woman presented with subacute onset of a left homonymous hemianopia. Contrast-enhanced magnetic resonance imaging of the brain revealed a T2-hyperintense lesion in the right thalamus, with associated subtle gadolinium enhancement ( Figure 1 ), and a small periventricular lesion. Although her visual symptoms were improving, a new left-sided hemiparesis developed 3 weeks later. Additional magnetic resonance imaging of the brain showed extension of the original thalamic lesion into the right internal capsule, with persistent contrast enhancement. Her visual and motor symptoms gradually improved over 3 months.