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- Title
Neurodegeneration: the pathologic evidence.
- Authors
Trapp BD
- Abstract
Multiple sclerosis (MS) is a chronic disease that is characterized by central nervous system (CNS) inflammation, demyelination, and neurodegeneration. Although the pathophysiology of MS is not completely understood, it is clear that much of the underlying disease process is clinically silent and continues even when patients are not experiencing symptoms. Most patients initially present with relapsing/remitting MS, in which acute disease episodes are separated by a return to normal or near-normal neurologic function. Eventually, most patients transition to secondary progressive MS, which is defined by the gradual accumulation of irreversible neurologic impairment. A consensus has recently begun to emerge that the long-term progressive disability in patients with MS is due to irreversible neurodegeneration, and that inflammation is less prominent in the later stage of the disorder. MS lesions exhibit extensive axonal transection and degeneration, and may involve both gray matter and white matter. Demyelination alone does not appear to cause axonal injury, and most axons survive transitory demyelination. However, axons that are chronically demyelinated are at substantial risk of degeneration. This may reflect the loss of important nerve growth factors that are produced by surrounding oligodendrocytes and that are essential for axonal survival. The gradualaccumulation of axonal injury probably contributes to the long-term atrophy of the CNS that is often observed in patients with chronic MS, and to the eventual progression of neurologic impairment. Early initiation of disease-modifying therapy may therefore help to slow long-term neurodegeneration and disease progression in patients with MS.
- Publication
Johns Hopkins Advanced Studies in Medicine, 2009, Vol 9, Issue 2, p37
- ISSN
1530-3004
- Publication type
Journal Article