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The Prototypic Neuroimmunological CNS Disease: Multiple Sclerosis, a Precis

  • Andrew R. Pachner
Chapter
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Abstract

Multiple sclerosis (MS) is a disease of the central nervous system primarily affecting young adults, usually characterized by the development of sudden exacerbations (attacks) with remissions of focal neurological dysfunction and the development of progressive neurological disability over time. Lesions in the CNS are continually accrued (“one and one and one…”) so that over time, the CNS is damaged as a function of the frequency and location of lesions balanced by as yet poorly understood reparative processes. It is characterized pathologically by inflammation and demyelination as well as remyelination exclusively in the central nervous system, with no pathology in the peripheral nervous system or non-nervous system tissue. Its cause is unknown and its treatment is currently suboptimal in that exacerbations and disease progression are not universally halted. It is a uniquely human condition and although there are animal models, none is fully faithful to the human disease. In some patients with MS, those with the primary progressive form of the disease, there is simply progression of disability without exacerbations or remissions.

Keywords

Multiple Sclerosis Multiple Sclerosis Patient Optic Neuritis Axonal Injury Multiple Sclerosis Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Waksman BH. Demyelinating disease: evolution of a paradigm. Neurochem Res. 1999;24(4):491–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Efficacy and toxicity of cyclosporine in chronic progressive multiple sclerosis: a randomized, double-blinded, placebo-controlled clinical trial. The Multiple Sclerosis Study Group. Ann Neurol. 1990;27(6):591–605.Google Scholar
  3. 3.
    McAlpine D, Compston ND, Lumsden CE. Multiple sclerosis. Edinburgh: E & S Livingston; 1955.Google Scholar
  4. 4.
    Poser CM, Brinar VV. Diagnostic criteria for multiple sclerosis: an historical review. Clin Neurol Neurosurg. 2004;106(3):147–58.PubMedCrossRefGoogle Scholar
  5. 5.
    Massacesi L, Genain CP, Lee-Parritz D, Letvin NL, Canfield D, Hauser SL. Active and passively induced experimental autoimmune encephalomyelitis in common marmosets: a new model for multiple sclerosis. Ann Neurol. 1995;37(4):519–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Lucchinetti CF, Bruck W, Rodriguez M, Lassmann H. Distinct patterns of multiple sclerosis pathology indicates heterogeneity on pathogenesis. Brain Pathol. 1996;6(3):259–74.PubMedCrossRefGoogle Scholar
  7. 7.
    Barnett MH, Parratt JD, Pollard JD, Prineas JW. MS: is it one disease? Int MS J. 2009;16(2):57–65.PubMedGoogle Scholar
  8. 8.
    Ebers GC. Environmental factors and multiple sclerosis. Lancet Neurol. 2008;7(3):268–77.PubMedCrossRefGoogle Scholar
  9. 9.
    Ramagopalan SV, Knight JC, Ebers GC. Multiple sclerosis and the major histocompatibility complex. Curr Opin Neurol. 2009;22(3):219–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Cadavid D, Wolansky LJ, Skurnick J, et al. Efficacy of treatment of MS with IFN{beta}-1b or glatiramer acetate by monthly brain MRI in the BECOME study. Neurology. 2009;72:1976–83.PubMedCrossRefGoogle Scholar
  11. 11.
    Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247–69.PubMedCrossRefGoogle Scholar
  12. 12.
    Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444–52.PubMedGoogle Scholar
  13. 13.
    Roxburgh RH, Seaman SR, Masterman T, et al. Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity. Neurology. 2005;64(7):1144–51.PubMedCrossRefGoogle Scholar
  14. 14.
    Lincoln JA, Cadavid D, Pollard J, et al. We should use magnetic resonance imaging to classify and monitor the course of multiple sclerosis. Arch Neurol. 2009;66(3):412–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Furby J, Hayton T, Anderson V, et al. Magnetic resonance imaging measures of brain and spinal cord atrophy correlate with clinical impairment in secondary progressive multiple sclerosis. Mult Scler. 2008;14(8):1068–75.PubMedCrossRefGoogle Scholar
  16. 16.
    Daumer M, Neuhaus A, Morrissey S, Hintzen R, Ebers GC. MRI as an outcome in multiple sclerosis clinical trials. Neurology. 2009;72(8):705–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Daumer M, Neuhaus A, Herbert J, Ebers G. Prognosis of the individual course of disease: the elements of time, heterogeneity and precision. J Neurol Sci. 2009;287 Suppl 1:S50–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Andrew R. Pachner
    • 1
  1. 1.Department of Neurology and Neuroscience New Jersey Medical SchoolUniversity of Medicine and Dentistry of New JerseyNewarkUSA

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