It's getting hard to keep track of recent developments regarding new therapeutics in neurology. From the relatively recent approval of new AEDs lacosamide and rufinamide, the approval of dextromethorphan hydrobromide and quinidine sulfate for the previously untreated indication of pseudobulbar affect, a slew of drugs in phase II and III trials, fampridine for improved walking ability in MS, and the approval of fingolimod to prevent exacerbations of MS, the therapeutic landscape is expanding rapidly.

With the availability of new drugs, clinicians and their patients have more and more options for care. Consider the case of fingolimod. Efficacy data, as summarized in this issue, are impressive. Plus, the fact that therapy is administered orally is a boon to many patients. But every therapeutic decision hinges on a balancing of risks and benefits for each individual patient based on the specifics of the case. As with any effective drug, the latest ones on the market are not without risks and side effects.

Decades ago, effective drugs came with side effects that were sometimes unpredicted and often not understood. This is not surprising, because mechanisms of action were often not well understood, either. In today's R&D environment, new molecules are developed with much greater precision, and the risks of therapy are much better understood. Furthermore, trials have become more rigorous, and the cumulative experience associated with a drug is extensive before it even reaches the market.

No drug is without risks. As also discussed in this issue, fingolimod is associated with risks for certain adverse events and may not be the right treatment for every MS patient. But it is a first of its kind drug that has opened a whole new approach to MS management and expanded the possibilities for patient care. The landscape is changing relatively quickly, and clinicians and patients must be prepared to understand the risks and benefits of therapies in order to reap the benefits of expanding treatment options.