[The interest of multiple sclerosis attacks. Physiopathology and therapy].
OBJECTIVE
To review the clinical concept of an attack, the physiopathological mechanisms underlying the symptoms of the attack, in the recovery phase, and those corresponding to the progressive or degenerative phase of the disease.


METHODS
Although they do not explain the exact mechanisms responsible for the onset of the attack or the processes that account for the clinical and pathological heterogeneity, most research studies suggest that the lesions produced in multiple sclerosis are the consequence of complex immunological interactions that take place mostly in the white matter of the central nervous system. These lesions affect, to variable extents, the myelin and the axon. We survey how these events are reflected in the images obtained by magnetic resonance. Clinical observations have shown that, in some patients, infections and hormones can exert an influence on the activity of the disease. Recovery, in the initial stages at least, would be produced by the action of poorly understood mechanisms that limit inflammation, and by local or cortical neuroplasticity or repair processes. Finally, we discuss the mechanisms behind the action of corticoids that justify their use when treating these attacks.


CONCLUSIONS
A more thorough understanding of these events opens up the way to providing better therapy in the future.
de Andrés
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Hospital General Universitario Gregorio Marañon, Madrid, España. jamarti@eresmas.net
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002490:Central Nervous System / Q000378:metabolism / Q000473:pathology; D018450:Disease Progression; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D006801:Humans; D007239:Infections / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology*; D010956:Plasmapheresis
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D012739:Gonadal Steroid Hormones