An update on immunopathogenesis, diagnosis, and treatment of multiple sclerosis

Abstract

Background: Multiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after head trauma.

Discussion: The etiology of MS is probably multifactorial, related to genetic, environmental, and several other factors. The pathogenesis is not fully understood but is believed to involve T-cell-mediated inflammation directed against myelin and other related proteins with a possible role for B cells. The McDonald criteria have been proposed and revised over the years to guide the diagnosis of MS and are based on clinical presentation and magnetic resonance imaging (MRI) of the brain and spinal cord to establish dissemination in time and space. The treatment of MS includes disease modification with immunomodulator drugs and symptom management to address the specific symptoms such as fatigue, spasticity, and pain.

Conclusion: An update on etiology, pathogenesis, diagnosis, and immunomodulatory treatment of MS is presented.

Keywords: Demyelination; diagnosis; etiology; immunomodulator; multiple sclerosis; pathogenesis; treatment.

Figure 1

Immunopathogenic mechanisms in MS and proposed targets of different disease modifying therapies.

Figure 2

Brain MRI axial fluid attenuated inversion recovery (FLAIR) image shows the characteristic periventricular areas of increased signal intensity (arrows) that are oriented perpendicular to and often contiguous with the lateral ventricles.

Figure 3

Treatment approach to patients with RRMS and CIS.