In the not so distant past, multiple sclerosis was often a devastating illness in many patients because neurologists did not have effective therapeutic options. The only standard treatment was bedrest during the acute attacks. When I started in my MS fellowship in 1987, there were two medications available - corticosteroids and ACTH. These medications were only effective in treating acute exacerbations or attacks of the disease. Starting in 1993 with the introduction of Betaseron and during the following 23 years 12 additional disease modifying medications were approved for the treatment of relapsing forms of multiple sclerosis. These therapies have had a significant impact on disease progression by decreasing lesion formation in the brain and spinal cord and decreasing acute MS attacks or relapses. In addition new symptomatic therapies have resulted in better control of fatigue, bladder problems, depression and spasticity. In many cases multiple sclerosis has become a manageable problem in many patients. Our biggest challenge at present in the field is treating disease progression in the absence of attacks or exacerbations. With the help of multiple sclerosis patients participating in clinical trials we will discover new agents to overcome the problem of treating disease progression.