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Multiple Sclerosis (MS), Dobson, R. and Giovannoni, G. (2019), Multiple…
Multiple Sclerosis (MS)
Pathology
Hallmark signs
Perivenular inflammation
Leads to demyelinating plaques
2 major forms
Progressive MS
Relapsing-remitting MS
What is it?
Most commonly develops in young adult years
The most common nontraumatic disabling disease
Classically thought to be T-cell mediated
successful B-cell targeting tests is changing this theory
Causes
Mostly environmental
Epstein-Barr virus
doubles the chances
EBV induced B cell immortalization has been thought to play a role in MS develpment
Smoking
Vitamin D or UVB exposure
Latitudes closer to the poles show higher number of MS cases.
Genetic
HLA-DRB*15 loci
HLA-DRB plays a role in antigen presentation
Heterozygotes for HLA-DRB alleles are less likely to develop MS
Development in 4 phases
Symptomatic
may be mono- or poly-
asymptomatic
1/10 lesions are actually symptomatic
At risk
Management
Treatment and monitoring are on going from diagnosis
Baselines are determined
MRI
Antibody and thyroid functions
Therapies
A number of therapies are available
Classic treatments were mostly immunosuppressants
Current research is into immune reconstruction
These are the closest to a cure for MS
Dobson, R. and Giovannoni, G. (2019), Multiple sclerosis – a review. Eur J Neurol, 26: 27-40.
https://doi.org/10.1111/ene.13819