Several laboratories including ours have shown that T cell co-stimulation mediated through B7-1 or B7-2 is critical to the initiation of EAE. The role of T cell co-stimulation in ongoing EAE is less clear. In the present study, 32 mice with established EAE were randomly assigned to receive treatment with either CTLA-4-Fc or control Ig. Mice were followed daily by clinical scoring for 2 months post-immunization. A significant improvement in the degree of recovery following the acute episode and following relapses of EAE was observed in those mice randomized to CTLA-4-Fc treatment. Full clinical remission occurred twice as often in the CTLA-4-Fc group as in those mice receiving placebo, whereas placebo-treated mice were more likely to develop a stable prolonged neurologic deficit. Serial clinical scoring revealed no effect of CTLA-4-Fc upon relapse rate, with greater than 80% of the mice in each group displaying at least one clinical EAE relapse. In that the activation of memory T cells is relatively independent of T cell co-stimulation, these results indicate that development of chronic disease is associated with the activation of naive T cells and the recruitment of the latter cells into the disease process. Blocking B7 molecules may be beneficial in the treatment of established CNS inflammatory demyelinating diseases such as multiple sclerosis.