Multiple sclerosis, a treatable disease

Abstract

This article reviews our current understanding and modern treatment of multiple sclerosis (MS). MS is a disabling condition resulting in devastating social and economic impacts. As MS can affect any part of the central nervous system, the presentation is often diverse; however, there are key features that can be useful in the clinic. We comment on the diagnostic criteria and review the main subtypes of MS, including clinically isolated syndrome, relapsing remitting MS, secondary progressive MS and primary progressive MS. Although the underlying aetiology of MS is still not known, we summarise those with most evidence of association. Finally, we aim to present treatment strategies for managing the acute relapse, disease-modifying therapies and MS symptoms. This review highlights that progressive MS is an area where there is currently a paucity of available diseasemodifying treatments and this will be a major focus for future development.KEYWORDS : Diagnostic criteria , epidemiology , multiple sclerosis , progressive multiple sclerosis , treatments What is multiple sclerosis?Multiple sclerosis (MS) is an acquired disabling neurological disease of young adults, affecting approximately 2.3 million people worldwide. It is most prevalent in North America (140 cases per 100,000) and Europe (108 cases per 100,000); the prevalence is lowest in sub-Saharan Africa (2.1 cases per 100,000) and East Asia (2.2 cases per 100,000).1 Overall, there are approximately 120,000 people with MS in the UK. 2MS is an inflammatory disease of the central nervous system (CNS), which causes a heterogeneous array of symptoms and signs because of differential involvement of motor, sensory, visual and autonomic systems. Optic neuritis (inflammation of the optic nerve), Uhthoff's phenomenon (transient fluctuation or worsening of MS symptoms with a rise in body temperature) and Lhermitte's phenomenon (an abnormal electric-shock like sensation down the spine or limbs on neck flexion) are characteristic of MS.3-5 MS relapses occur because of focal areas ABSTRACTMultiple sclerosis, a treatable disease of demyelination evolving over 24 hours and persisting for days or weeks before generally, though not exclusively, improving.4,6

Activated Protein C Attenuates Experimental Autoimmune Encephalomyelitis Progression by Enhancing Vascular Integrity and Suppressing Microglial Activation

“…Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) and is the most common neurological disease in the young to middle age population, affecting more than 400,000 people in the United States (Wingerchuk and Carter, 2014;Doshi and Chataway, 2017). While the precise trigger of MS is unknown, it typically presents with a spectrum of neurological symptoms that include blindness, altered sensation, weakness and eventually paralysis and cognitive defects.…”

“…This activity has generated a large number of disease-modifying therapies (DMTs), several of which are effective at suppressing the inflammatory aspect of MS. To date, most of these drugs have been designed to target cells of the immune system, suppressing their activation, proliferation, or egression from peripheral lymph nodes or their transmigration into the CNS. It should be noted that while each of the drugs offer significant benefits in certain sub-populations of MS patients, because of the heterogeneity of the disease, none of the drugs is effective in all patients, and in some types of MS, particularly the chronic progressive form, few therapeutic options are currently available (Wingerchuk and Carter, 2014;Doshi and Chataway, 2017).…”

Hypoxic pre-conditioning suppresses experimental autoimmune encephalomyelitis by modifying multiple properties of blood vessels

“…Multiple sclerosis (MS) is the most common neurological disease in the young-middle age population, affecting more than 400,000 people in the United States [9, 44]. At the pathological level, MS is an autoimmune disease in which inflammatory leukocytes directed against myelin antigens, infiltrate the CNS (brain and spinal cord) to establish a chronic inflammatory response that results in demyelination and axonal degeneration [16, 27].…”

Factors associated with relapses in relapsing-remitting multiple sclerosis

“…[ 1 ] Approximately 85% of patients have a relapsing-remitting course from onset. Although a large expansion treatment options for MS have occurred in recent 20 years, [ 2 ] there is no curative treatment available, and the aim of current therapeutic strategy is to reduce the risk of relapse. [ 3 ] It is of great significance to pathogenesis and prevention of MS by studying the factor associated with relapses.…”