Treating Multiple Sclerosis With Monoclonal Antibodies

Mathias Buttman, MD; Peter Rieckmann, MD, FRCPC

Disclosures

Expert Rev Neurother. 2008;8(3):433-455. 

In This Article

Introduction to Multiple Sclerosis

Multiple sclerosis is an incurable, but in many cases successfully treatable, chronic inflammatory disease of the CNS, affecting approximately 2.5 million people worldwide.[6] Although substantial therapeutic progress has been made during the past 20 years, it is still the most frequent cause of nontraumatic, permanent neurological disability in young adults.[7] Based on individual genetic susceptibility, autoimmune reactions against glyco-protein components of the CNS and distinctly different neurodegenerative processes are thought to play major roles in its pathogenesis.[8] Despite a wealth of knowledge on the pathogenesis of the disease, a primary cause of MS is still unknown.

In approximately 85% of patients, MS starts with subacute bouts of various neurological symptoms, establishing within hours to a few days and partially or completely resolving within weeks to months. The disease course may continue as RRMS, with no or only minor permanent disability over more than 10 years in the case of benign MS.[9] Alternatively, it may become progressive after several years with accumulating permanent disability, which is then called secondary progressive MS (SPMS).[10] Approximately 10-15% of patients experience a primary progressive MS (PPMS) disease course.[11,12] Less well-defined forms such as transitional progressive MS may occur.[13,14] The McDonald diagnostic criteria from 2001 are currently widely used to establish a diagnosis of MS.[15,16]

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