Introduction The treatment of multiple sclerosis (MS) is entering a new era, characterized by the availability of a broad range of disease modifying drugs (DMDs) for patients in the relapsing-remitting (RR) phase of the disease. Through interference with immunemediated inflammatory processes the DMDs reduce the number and severity of relapses and the increase in relapse-related disability. Each DMD is characterized by a unique combination of mode of action, route of administration, degree of

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... icacy and potential side effects. In the past two decades the injectable drugs interferon beta-1a (INFb-1a), INFb-1b and glatiramer acetate (GA) have been proven to be safe first-line treatments. In more recent years, the intravenously administered monoclonal antibody natalizumab and the oral drugs fingolimod and cladribine have been demonstrated to be efficacious in RRMS. These DMDs are more potent, but also potentially more hazardous, which by and large restricts their use to patients who have very active disease or are refractory to firstline treatment. Lately, phase II/III studies showed beneficial effects of the oral drugs teriflunomide, laquinimod and BG-12, and the monoclonal antibodies rituximab and alemtuzumab in RRMS. The advent of the new treatments coincides with the Web 2.0 evolution of the internet technology. Web 2.0 offers patients, doctors, and nurses unforeseen possibilities to fundamentally change, and hopefully improve, the ways in which care is delivered and clinical, patient-centered research is performed. The term Web 2.0 is associated with web applications that facilitate participatory information sharing, inter-operability, user-centered design and collaboration on the World Wide Web [1]. A Web 2.0 site allows users to interact and collaborate with each other, e.g. as creators of user-generated content in a virtual community, in contrast to websites where users are limited to the passive viewing of content that was created for them [2]. Basically, e-health 2.0 can be defined as the merging of the Web 2.0 phenomenon within health care [3]. However, e-health 2.0 goes beyond the social networking technology to include a reformative or even revolutionary change in the fields of health care and clinical research [3]. According to O'Grady the main point of e-health 2.0 is the use of social software and its ability to promote collaboration between patients, their caregivers, and medical professionals [3]. Thus, using the web to exchange information with others substantially relates to learning and education about an illness, what treatment options are www.intechopen.com Immunosuppression -Role in Health and Diseases 458 available, how to make decisions, and for support [3]. In a broad sense, it can be conceived that Web 2.0 technologies enable and facilitate social networking, participation, openness, and collaboration, within and between health care consumers, caregivers, patients, health professionals, and biomedical researchers [4] . This chapter highlights actual developments at the crossroads of MS treatment and research and interactive applications of the internet, thereby focusing on online self-assessment, interactive web-based care and interactive phase IV research, and their potential for patient empowerment. Multiple sclerosis 2.1 Disease characteristics MS is a chronic disease of the central nervous system (CNS) that is pathologically characterized by multiple areas of inflammation, demyelination, axonal loss and gliosis, predominantly but not exclusively in the white matter. Compared to other chronic CNS disorders MS is distinguished by a wide range of symptoms and a highly variable course. Typical clinical features are optic neuritis, paresis, diplopia, paresthesias, incoordination, bladder and bowel disturbances, cognitive dysfunction, anxiety, depression and fatigue [5] . In most patients the onset of disease is between 20 and 40 years of age. In 80% to 85% of the patients the initial phase is characterized by relapses and remissions: RRMS. Relapse / remission episodes are alternated by relatively stable periods of months to years. During a relapse symptoms typically evolve over days to weeks, and after a plateau phase often spontaneously improve, completely or incompletely. The total duration of a relapse / remission episode, from initial symptom to final recovery, varies from less than a week to more than half a year. To explain the etiology of MS it is thought that myelin-specific auto-reactive lymphocytes are primed in the periphery by unknown factors, after which they migrate to the CNS, leading to inflammatory demyelination and axonal loss [6] . Recent studies have suggested that the innate immune system also plays a role both in the initiation and progression of MS [6] . Inflammation composed of mononuclear cells, breakdown of the blood brain barrier, focal plaques of demyelination and axonal damage characterize the acute MS lesions and underlie relapses [7] . Importantly, the frequency and severity of the immune-mediated changes can be reduced by DMDs. As the disease duration increases the tendency of relapses to recover diminishes, which results in a higher risk of relapse-related deficits and a step-wise accrual of disability. Eventually, after a period of 10 to 20 years, most RRMS patients transgress to the secondary progressive phase (SPMS), characterized by a relentless continuous progression of disability. In about 15% of the MS patients symptoms start insidiously and continue to slowly progress without relapses, the primary progressive course (PPMS). In both SPMS and PPMS clinical deficits mainly result from axonal degeneration, whereas inflammation plays only a minor role. Accordingly, DMDs are not efficacious in SPMS and PPMS. Diagnosis In the last two decades the sensitivity and specificity of the MS diagnosis has considerably improved due to two developments. Firstly, the wide-spread use of the magnetic resonance imaging (MRI) technique for detection of lesions in brain and spinal cord, and secondly,