Multiple Sclerosis

This chapter presents a discussion on multiple sclerosis (MS). MS is the most frequent demyelinating central nervous system (CNS) disease among Northern Europeans and Northern Americans. The etiology of MS is still unclear, but it is now widely accepted that an autoimmune response directed at myelin antigens contributes to the pathogenesis. Findings supporting this hypothesis include the histopathology of the MS lesion, which reflects an inflammatory process consisting mainly of lymphocytes and macrophages, the association with certain HLA-class II antigens, and parallels to a well-described animal model for autoimmune demyelinating disease, experimental allergic encephalomyelitis (EAE). MS is a disease of young adulthood and mostly manifests between the ages of 20 and 40 years. Only a few percent of patients have the disease develop before 15 and after 55 years of age. Females are affected 1.5-2 times more frequently than males. Most often, MS begins as a relapsing remitting disease characterized by acute exacerbations or episodes of acute neurological dysfunction that improve, often completely, over a period of weeks without any treatment. The discussion on currently applied therapeutic strategies include glucocorticoids, interferon-beta (IFN-β), glatiramer acetate, intravenous immunoglobulins (iv-IG), and so on. The discussion on immunosuppressive treatment also includes mitoxantrone (MIX), azathioprine (AZA), cyclophosphamide (CTX), cyclosporine A (CSA), and others.