Neurodegeneration in Multiple Sclerosis: Relationship to Neurological Disability
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- Bruce D. Trapp
- Departments of Neurosciences, The Cleveland Clinic Foundation Cleveland, Ohio
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- Richard M. Ransohoff
- Departments of Neurosciences, Lerner Research Institute and the Mellen Center for Multiple Sclerosis Treatment and Research (RMR, RAR) The Cleveland Clinic Foundation Cleveland, Ohio
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- Elizabeth Fisher
- Biomedical Engineering, The Cleveland Clinic Foundation Cleveland, Ohio
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- Richard A. Rudick
- Departments of Neurosciences, Lerner Research Institute and the Mellen Center for Multiple Sclerosis Treatment and Research (RMR, RAR) The Cleveland Clinic Foundation Cleveland, Ohio
説明
<jats:p> Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS. Most MS patients follow a relapsing-remitting course (RR-MS) for 8 to 15 years that transforms into a secondary progressive disease course (SP-MS). In this review, we discuss current data that describe MS as a neurodegenerative disease in which axonal loss is the major cause of irreversible neurological disability in MS patients. Neurological deficits in MS patients have two pathogeneses: acute inflammatory demyelination and axonal degeneration. Disability caused by inflammatory demyelination clinically dominates the early stages of RR-MS and is reversible. Axonal transection occurs at sites of inflammation and begins at disease onset but is clinically silent in RR-MS because the CNS compensates for neuronal loss. Once a threshold of axon loss is ex ceeded, MS patients enter an irreversible secondary progressive stage. In SP-MS, axonal degeneration is caused by chronic demyelination and may be irreversibly progressive. This view of MS provides a concep tional framework that explains conversion of RR-MS to SP-MS and provides a rationale for early aggressive anti-inflammatory and neuroprotective therapies. NEUROSCIENTIST 5:48-57, 1999 </jats:p>
収録刊行物
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- The Neuroscientist
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The Neuroscientist 5 (1), 48-57, 1999-01
SAGE Publications