Multiple Sclerosis: Clinical Features, Pathophysiology, Diagnosis, and Management Publisher



Rahmanzadeh R¹ ; Moghadasi AN¹ ; Navardi S¹ ; Minagar A² ; Sahraian MA¹ Show Affiliations
Source: Neuroinflammation Published:2018

Abstract

Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system that usually affects young adults. The disease affects about 2.5 million people worldwide and is more frequently seen in females. The prevalence of MS appears to be different in various parts of the world, ranging from less than 5/100,000 in some African countries to more than 200/100,000 in Western Europe and North America (Kingwell et al., 2013). MS was first described by the French neurologist Jean-Martin Charcot who, in 1868, assimilated these findings into a single syndrome he called “sclerose en plaques,” and characterized it as a distinct neurological disease whilst clarifying some clinical and pathological features of the disease. The etiology of this potentially debilitating disease is still unknown but both environmental and genetic factors interact in disease development and progression. Many environmental factors such as vitamin D deficiency, viral infections such as Epstein Barr Virus (EBV), and smoking have been mentioned as triggering factors in genetically susceptible people. To date no single gene or locus has been found to be the gene for MS but several class II major histocompatibility complex (MHC) genes such as HLA DRB1*1501-DQA1*0102-DQB1*0602 alleles have been demonstrated to be associated with MS susceptibility. Over recent decades MS has been presented with its two different aspects of inflammation and degeneration. Although there are several approved and nonapproved medications to overcome or at least control the inflammatory aspect of the disease, at present there is no accepted therapy for controlling the degenerative phase, which may start even at the early stages of the disease. This chapter covers the clinical manifestations, pathophysiology, diagnosis, and treatment strategies in MS. There are several new disease-modifying therapies that have been approved recently, and there are several options in the pipeline that will be added to the currently approved ones. Recent approved drugs have been associated with rare but serious adverse events that need close monitoring and proper clinical or radiological vigilance in order to reduce catastrophic complications from these drugs. © 2018 Elsevier Inc. All rights reserved.