[Clinical and pathological topics of multiple sclerosis].
Therapeutic options for patients with progressive multiple sclerosis are currently limited. This is in part due to lack of knowledge regarding the pathophysiology of the disease in this stage. This review summarizes recent findings, showing profound differences in the pathology between relapsing and progressive MS. Pathological hallmarks in progressive MS are slow expansion of pre-existing white matter lesions, massive cortical demyelination and extensive diffuse injury of the normal appearing white matter. As in relapsing MS also in progressive MS active tissue injury is invariably associated with inflammation, but inflammation seems to be trapped behind a closed blood brain barrier. Different immunological mechanisms are involved in tissue destruction in progressive MS, but inflammation induced mitochondrial injury appears to be a dominant pathway. Future therapeutic interventions will have to target inflammation, which is compartmentalized in the central nervous system. In addition, however, neuroprotective therapies may be necessary.
Lassmann
Hans
H
Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Wien, Austria.
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000473:pathology; D002490:Central Nervous System / Q000473:pathology; D003711:Demyelinating Diseases; D018450:Disease Progression; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007249:Inflammation; D008928:Mitochondria / Q000473:pathology; D009103:Multiple Sclerosis / Q000276:immunology / Q000473:pathology / Q000628:therapy; D009410:Nerve Degeneration; D018696:Neuroprotective Agents / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D018696:Neuroprotective Agents