Different infections, including Epstein Barr virus (EBV), may also play a role. Vitamin D deficiency has been considered a possible etiology for the noted predisposition of the population in higher latitudes being affected. Įnvironmental factors, including latitudinal gradients in different countries, have been well-studied phenomena. The “inside-out” hypothesis suggests an intrinsic CNS abnormality that triggers and results in inflammatory-mediated tissue damage. Researchers hypothesize that an unknown antigen triggers and activates both Th1 and Th17, leading to CNS endothelium attachment, the crossing of the blood-brain barrier, and subsequent immune attack through cross-reactivity. Although there are various proposed hypothetical mechanisms, the postulated “out-side-in” mechanism involves CD4+ proinflammatory T cells. Long-term therapy aims at reducing the risk of permanent disability.ĭysimmunity with an autoimmune attack on the central nervous system is the leading hypothesized etiology of MS. Treatment aims at decreasing relapses and MRI activity. Although different diagnostic criteria have been used for MS, the general principle of diagnosing the RR course has involved establishing episodes separated in "time and space." This means that episodes must be separated in time and affect different locations of the CNS. Making the diagnosis of MS expeditiously allows for the early and effective institution of disease-modifying therapy.
The diagnosis of RR MS is made with at least two CNS inflammatory events. Over time, residual symptoms from relapses without complete recovery accumulate and contribute to general disability. Relapses often recover either partially or completely over weeks and months, frequently without treatment. When discussing MS, clinicians most often describe the RR course, considering its high prevalence amongst affected patients. The following three categories are sometimes included in the spectrum of MS:ĥ) Clinically isolated syndrome (CIS): often classified as a single episode of inflammatory CNS demyelination.Ħ) Fulminant: characterized by severe MS with multiple relapses and rapid progression towards disability.ħ) Benign: a clinical course characterized by an overall mild disability. Superimposed relapses can be a feature of this clinical course, as well, although this is not a mandatory feature.Ĥ) Progressive-relapsing (PR) MS: in 5% of patients, a gradual deterioration with superimposed relapses occurs. 2) Primary progressive (PP): 15 to 20% of patients present with a gradual deterioration from the onset, with an absence of relapses.ģ) Secondary progressive (SP): this is characterized by a more gradual neurologic deterioration after an initial RR course.
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