Multiple Sclerosis: Clinical Features, Pathophysiology, Neuroimaging, and Future Therapies

Aimee Pasqua Borazanci; Meghan K. Harris; Robert N. Schwendimann; Eduardo Gonzalez-Toledo; Amir H. Maghzi; Masoud Etemadifar; Nadejda Alekseeva; James Pinkston; Roger E. Kelley; Alireza Minagar

Disclosures

Future Neurology. 2009;4(2):229-246. 

In This Article

Abstract and Introduction

Abstract

Multiple sclerosis (MS) is a common immune-mediated progressive neurodegenerative disease of the CNS that typically manifests with periods of disease activity followed by intervals of remission. The etiology of MS remains unknown; however, existing evidence indicates that MS is a ‘whole-brain disease' that is driven by a potent immune response against CNS antigen(s), particularly myelin peptide antigens. The immunopathogenesis of MS includes both the cell- and humorally-mediated arms of the immune system. Genetic and environmental factors play important roles in the development of MS. Application of various neuroimaging techniques to the world of MS have expanded our knowledge concerning its pathogenesis and assist us in the more accurate diagnosis of MS versus its imitators. Current treatments target acute attacks and aim to reduce future clinical relapses. A summary of the potential future therapies for MS is presented.

Introduction

Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease of the human CNS that affects more than 2 million individuals around the globe and more than 500,000 people in the USA.[1,2] MS remains a significant cause of neurologic disability in young adults[2] and places a heavy medical, psychological and financial burden on human society. Despite major attempts to unravel the etiology of MS, its cause and cure remain elusive. The pathogenesis of MS consists of two arms: an inflammatory arm, which is associated with a potent cellular and humoral immune response against potential CNS antigen(s), and a neurodegenerative arm, which promotes neuronal loss and translates into brain atrophy.[3,4,5] Until 1993, no specific treatments for MS were available. However, there are now six US FDA-approved treatments for MS with various mechanism(s) of action and potency. Our purpose is to provide an updated review of clinical features, genetic epidemiology, neuroimaging characteristics and future therapies for MS.

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