What is it about?
Multiple sclerosis (MS) remains a crucial unsolved problem in the field of neurosciences, being also a serious cause of suffering for millions of patients worldwide affecting the quality of life, the personal and social economy, and the psychosomatic homeostasis substantially in the majority of the patients. The etiopathological background of the disease, which is a progressive inflammation of the CNS, inducing demyelination in the white matter and degenerative alterations in the gray matter in various areas of the brain hemispheres, the cerebellum, the brain stem, and the spinal cord, may provoke a multitude of polymorphic clinical phenomena inducing a variable type of physical, mental, and social disability in the suffering people.
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Why is it important?
Diagnostic criteria for multiple sclerosis have been proposed and introduced for many years and have been revised over times. Most of them may simply facilitate the approach of the diagnosis of the disease. In general, the clinical estimation of the patients and the incorporation of data from the paraclinical investigation, especially from MRI, diffusion imaging, resting state functional MRI, magnetic resonance spectroscopy, evoked potentials, optical coherence tomography (OCT) , OCT angiography, and immunological analysis of the CSF, may lead to a prompt diagnosis of the disease even in patients with atypical clinical manifestations and marked course heterogeneity. In the cases that clinical and neuroimaging data are atypical or inadequate for posing the diagnosis of MS, the findings of oligoclonal band and immunoglobulin G (IgG) level in the cerebrospinal fluid analysis, in correlation with the serum data, would be a strong argument of intrathecal inflammation, advocating in favor of the diagnosis of MS. However, in the differential diagnosis of multiple sclerosis, a substantial number of other conditions mimicking the clinical manifestations of the disease should be under consideration. Among them, the neuromyelitis optica spectrum disorder (Devic’s disease) would be differentially diagnosed on the basis of anti-aquaporin 4 antibody (AQP4-IgG), the acute disseminated encephalomyelitis (ADEM) on the basis of the clinical profile and the neuroimaging data, the MOG antibody disease on the basis of the level of MOG antibodies, and the antiphospholipid syndrome by the detection of lupus anticoagulant and anticardiolipin antibodies [36]. In addition systemic lupus erythematosus, small vessel disease, and Susac’s syndrome have a substantial place in the expanded spectrum of the differential diagnosis of MS. Disease activity is usually estimated by the clinical relapses and the MRI findings of contrast-enhanced lesions, enabling the detection of new lesions on T2-weighted images. However, a reasonable criticism and a periodic reevaluation of the adopted diagnostic criteria would be of substantial importance for the accuracy of the prompt diagnosis of MS.
Perspectives
There is no definite targeted therapeutic approach for MS. The application of many current treatments aims at ameliorating the quality of life of the patients by reducing the disability progression and stabilizing the clinical condition of the patients. The introduction of interferon in 1993 opened the horizons of many potential therapeutic options of various efficacy and side effects, which turned to raise many reasonable controversies from the viewpoint of the heterogeneity of the disease, the obscure etiopathological background, and the complexity of the pathophysiological mechanisms . An efficient therapeutic strategy should be based on a clear knowledge of the pathogenetic mechanisms of the disease. The investigation of the role of the myeloid cells and the infiltration of the CNS by peripheral lymphoid and myeloid cells may be crucial for a deeper understanding of the progression of the disease and the chronicity of the clinical phenomena. There is no definite targeted therapeutic approach for MS [40–42]. The application of many current treatments aims at ameliorating the quality of life of the patients by reducing the disability progression and stabilizing the clinical condition of the patients [43]. The introduction of interferon in 1993 opened the horizons of many potential therapeutic options of various efficacy and side effects, which turned to raise many reasonable controversies from the viewpoint of the heterogeneity of the disease, the obscure etiopathological background, and the complexity of the pathophysiological mechanisms [44]. An efficient therapeutic strategy should be based on a clear knowledge of the pathogenetic mechanisms of the disease. The investigation of the role of the myeloid cells and the infiltration of the CNS by peripheral lymphoid and myeloid cells may be crucial for a deeper understanding of the progression of the disease and the chronicity of the clinical phenomena [45, 46]. Novel therapeutical attempts aiming at modulating the activities and reactions of myeloid cells might be hopeful in treating MS patients at the initial stages of the disease. In addition the application of autologous EBV-specific T cell therapy may improve the clinical condition of the patients, ameliorating consequently the quality of life in a substantial number of them [47–49]. Non-pharmacological therapies [50], such as appropriate diet [51], proper environment, physical exercise [52], psychological relaxation [53] and progressive muscle relaxation therapy (PMRT), psychotherapy [54], cognitive behavioral therapy [55], music therapy [56], and emotional, social, and spiritual support [57] may also play a considerable beneficial role in the amelioration of the quality of life in the large majority of the patients. In addition the application of autologous EBV-specific T cell therapy may improve the clinical condition of the patients, ameliorating consequently the quality of life in a substantial number of them .Non-pharmacological therapies [50], such as appropriate diet [51], proper environment, physical exercise , psychological relaxation and progressive muscle relaxation therapy (PMRT), psychotherapy, cognitive behavioral therapy, music therapy , and emotional, social, and spiritual support may also play a considerable beneficial role in the amelioration of the quality of life in the large majority of the patients.
Professor Stavros J Baloyannis or Balogiannis or Balojannis or Baloyiannis or Mpalogiannis
Aristotle University of Thessaloniki
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This page is a summary of: Multiple Sclerosis, January 2020, IntechOpen,
DOI: 10.5772/intechopen.78425.
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