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Multiple sclerosis (MS) is a chronic inflammatory disorder related to Central Nervous System; it affects brain and spinal cord. Primary MS symptoms include tingling, weakness, numbness, and hazy vision. While some other signs are linked to thinking problems, muscular stiffness, body balancing during walk and urinary problems.
Multiple sclerosis is manifested morphologically by inflammation and primary demyelination of neurons. The dispersed inflammatory lesions are distinguished by immense permeation of varied cellular mediators of the immune system that includes T and B cells, macrophages and microglia. Some soluble mediators like cytokines, antibodies, and other toxic substances are also caught up. The manifestation of such lesions is related with clinical deterioration and now is pathological characteristic for Multiple Sclerosis.
Though, the pathology of MS was firstly described more than a century ago. The microscopic investigation was described by Carswell, who showed the perivenous distribution of lesions associated with inflammation and critical structural changes such as demyelination, axonal devastation and glial scarring. The art of MS pathology was first summarized by a French neurologist Charcot. (Lassmann, 1999, p. 1635)
Although these lesions were familiar for a long time but due to recent development and achievements in Neuro-biology and immunology we have started to recognize the severity of this disease, it is not as plain as it was thought to be. Despite recent advancement in the diagnosis and treatment of MS, we still are deficient in consensus about pathogenesis, causes and mechanisms of the disease evolution. There is no absolute cure for MS yet. Recent detailed immuno-pathological studies depict that the treatment can alleviate MS symptoms and holdup disease progression. During the remission, declaration of inflammation is the main factor which directs to clinical improvement of patients. At this stage, the immune system plays a beneficial role. Physical and cognitive therapies and other treatments like emotional support can help control symptoms and improve the quality of life. Current evidence specifies that MS is an inflammatory neurodegenerative disorder where innate and adaptive; both types of immunity play an important role in the commencement, as well as in the maintenance of the disease.
In addition, the pathological studies show that the process remyelintaion occurs only in the early stages, but slows down as the disease aggravates. Thus, simple immuno-anti-inflammatory strategies will not work here. Now it is necessary to identify and halt those neuro-degenerative molecular pathways that lead to structural and functional degeneration and prevent renaissance, in order to design new therapeutic strategies that can stop or even reverse disease progression.
As it is seen that the T-cells have a major role in disease progression, now scientists are targeting the interaction between T-cells and microglial cells that might reduce the progressive activation and obstruct the neurodegenerative phase of diseases. (Bruck, 2005) Magnetic resonance imaging (MRI) is also found sensitive to focal MS lesions. That’s why the conventional MRI based techniques with advanced pathological specificity like magnetization transfer-MRI or proton MR spectroscopy have been broadly applied to measure disease within crucial visible lesions. These methods pooled with functional imaging techniques, are progressively helpful in identifying the factors associated with MS evolution. (Filippi et al., 2011, p. 1514)
Though no concrete treatment is available yet except for moral support and various cognitive strategies, scientists are working and hopeful for better treatment options.
References
Lassman, H. (1999, October 29). The pathology of multiple sclerosis and its evolution.
Philos Trans R Soc Lond B Biol Sci., 354, 1635-1640. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692680/
Bruck, W. (2005). The pathology of multiple sclerosis is the result of focal inflammatory
demyelination with axonal damage J Neurol. 252 [Suppl 5]:V3–9. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16254699
Filippi, M., Rocca, M. A., De Stefano, N., Enzinger, C., Fisher, E., Horsfield, M. A., Inglese, M.,
Pelletier, D. & Comi, G. (2011). Magnetic resonance techniques in multiple sclerosis: the
present and the future. Arch Neurol. 68(12), 1514-20 Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/22159052
