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Aetiology and pathogenesis of multiple sclerosis

By Graham G. Niepel and Cris S. Constantinescu

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS).1 It was in the 1830s when Cruveilhier and Carswell first presented reports and provided illustrations of pathological specimens that later proved to be consistent with MS.

In 1868, Charcot produced his lectures on “Sclerose en plaques”, providing the first detailed clinico-pathological description of the new disease, now termed multiple, or disseminated, sclerosis.

By consensus, there are four main clinical categories of MS.2 The commonest is relapsing remitting MS (RR-MS), which affects 80-85 per cent of patients. These patients develop disease relapses, often without a specific trigger but possibly associated with infections. Disease relapses can last between 24 hours and several months, and patients may, or may not, completely recover. Patients are clinically stable between relapses, although they can have residual symptoms and disability.

After several years, the majority (70 per cent) of these patients will develop secondary progressive disease (SP-MS), whereby they experience a progressive neurological deterioration. They may still suffer from superimposed relapses. A subcategory of RR-MS patients (between 15 and 20 per cent) have benign MS. These patients have rare and mild relapses and a long course of disease, with minimal or no disability.

If patients have a steady neurological decline from the outset, without relapses, they are described as having primary progressive MS (PP-MS). This comprises approximately 15-20 per cent of sufferers. A fourth, rare category of patients is progressive relapsing MS (PR-MS), which is considered a variant of PP-MS, with similar prognosis. In patients with PR-MS, there is a gradual neurological decline from the beginning. It is similar to PP-MS, but has superimposed, acute relapses.

Epidemiology

The prevalence of MS in the United Kingdom is approximately 120 per 100,000, with an incidence of seven new cases per 100,000 per year.

Download the attached PDF to read the full article.

Citation: Hospital Pharmacist URI: 10976495

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