Jan 29, 2019

Pathogenic Mechanisms Associated With Different Clinical Courses of Multiple Sclerosis

Frontiers in Immunology
Hans Lassmann


In the majority of patients multiple sclerosis starts with a relapsing remitting course (RRMS), which may at later times transform into secondary progressive disease (SPMS). In a minority of patients the relapsing remitting disease is skipped and the patients show progression from the onset (primary progressive MS, PPMS). Evidence obtained so far indicate major differences between RRMS and progressive MS, but no essential differences between SPMS and PPMS, with the exception of a lower incidence in the global load of focal white matter lesions and in particular in the presence of classical active plaques in PPMS. We suggest that in MS patients two types of inflammation occur, which develop in parallel but partially independent from each other. The first is the focal bulk invasion of T- and B-lymphocytes with profound blood brain barrier leakage, which predominately affects the white matter, and which gives rise to classical active demyelinated plaques. The other type of inflammation is a slow accumulation of T-cells and B-cells in the absence of major blood brain barrier damage in the connective tissue spaces of the brain, such as the meninges and the large perivascular Virchow Robin spaces, where they may form aggregates or in...Continue Reading

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Mentioned in this Paper

Inflammation Mediators
Tissue Damage
Nerve Degeneration
Gray Matter
Structure of virchow-Robin Space
Anatomical Space Structure
CD8-Positive T-Lymphocytes

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