An Overview of Multiple Sclerosis: Diagnosis and Management Strategies

Kathleen Costello, RN, MS, CRNP, MSCN; Colleen J. Harris, RN, MN, NP, MSCN


Topics in Advanced Practice Nursing eJournal. 2006;6(1) 

In This Article


Pathologically, there is damage to the myelin as well as damage to the underlying axon. Although initially thought to occur late in the disease, Trapp and colleagues[7] demonstrated that axonal damage occurs early as well as later in the disease process

Gray matter, once thought to be spared in MS, has also been shown to be damaged in MS. The damage appears to be due to an inflammatory process in which lymphocytes that can react to CNS tissue become activated in the periphery, disrupt the intracellular matrix of the blood brain barrier, and enter the CNS tissue. Once in the CNS, reactivation occurs and various other inflammatory cells are recruited to the area.

Inflammatory cytokines, macrophages, microglia, antibodies, free radicals, and complement may all act to damage myelin and underlying axons. Current treatments, directed at the underlying MS disease process, target this inflammatory response.[8,9,10] Inflammatory changes within the CNS are characteristic of the relapsing-remitting type of MS, while more degenerative changes are characteristic of progressive forms of MS. Large numbers of inflammatory cells are seen in new lesions, but fewer are seen in older, more chronic lesions.


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