Early Indicators Early Treatments Neuroprotection In Multiple Sclerosis (topics In Neuroscience)

There is now evidence that irreversible brain damage accumulates very early in the course of multiple sclerosis. This book reviews the main neurobiological, magnetic resonance imaging, and clinical aspects of the early phases of the dis­ ease. Mechanisms ofirreversible axonal damage and the role played by the inter­ action of glia and the axon are highlighted. In contrast to what was believed for a long time, the sufficient availability of oligodendrocyte precursor cells to promote remyelination in acute lesions has now been demonstrated. For reasons not understood, this remyelination process fails or does not start, particularly in the chronic stages ofthe disease. These findings emphasize the importance of the "milieu" changes induced by an inflammatory process in limiting remyelination. However, first indications are that part of this inflammatory process may have a neuroprotective effect. Pathological studies in multiple sclerosis have now clearly demonstrated that destructive processes may be followed by recovery phases in such a way that myelin may be morphologically and functionally reconstituted. These findings provide the rationale for early treatment and emphasize the importance of clinical trials in early multiple sclerosis. Early treatment is one of the most important aspects in multiple sclerosis today. Front Matter....Pages I-XV Evidence for an Early Treatment of Multiple Sclerosis....Pages 1-13 Inflammation, Demyelination, and Axonal Degeneration: Three Aspects of the Pathogenesis of Multiple Sclerosis Revealed by Campath-1H Treatment....Pages 15-25 Genetic Regulation of Nerve Cell Death/Glial Activation and Protective Effects of Myelin Basic Protein Autoimmune Neurotrophin Production in Mechanically Induced Neurodegeneration....Pages 27-39 Neuroprotective Treatment in Primary Progressive Multiple Sclerosis: a Phase I/II Study with Riluzole....Pages 41-47 Neuropathology and Disease Progression in Multiple Sclerosis....Pages 49-61 Autoimmune Inflammation and Multiple Sclerosis....Pages 63-66 Early Treatment of Progression in Multiple Sclerosis....Pages 67-81 Imaging for Tissue Characterization in Multiple Sclerosis and Other White Matter Diseases....Pages 83-95 Monounsaturated Fatty Acids and Neuroprotection. The Results of a Study of Cognitive Decline in Old Age. Is There a Case for this Treatment in Multiple Sclerosis?....Pages 97-107 Neuroprotection in Acute Ischemic Stroke: Lessons for Early Treatment in Multiple Sclerosis....Pages 109-114 Soluble VCAM-1 Release Indicates Inflammatory Blood-Brain Barrier Pathology and Further Modulates Adhesion....Pages 115-117 Early Treatment in Multiple Sclerosis with Intravenous Immunoglobulin: Rationale and Study Design....Pages 119-128 Serial Magnetic Resonance Imaging in Patients with a First Clinical Episode Suggestive of Multiple Sclerosis: Outline of a Research Protocol....Pages 129-133 T1-Hypointense Lesions (T1 Black Holes) in Mild-to-Moderate Disability Relapsing Multiple Sclerosis....Pages 135-139 Acute Monosymptomatic Optic Neuritis: Potential Clues to Early Therapy in Multiple Sclerosis....Pages 141-153 Antibody Mediated Demyelination....Pages 155-161 Anti-MOG Antibodies as Early Predictors for Conversion to Relapsing-Remitting Disease Course in Patients Suggestive of Multiple Sclerosis....Pages 163-166 Sunlight, Vitamin D, and Multiple Sclerosis....Pages 167-179 The Yin and Yang of Inflammation in Multiple Sclerosis....Pages 181-189 Management of Interferon-β1b (Betaseron) Failures in Multiple Sclerosis with Interferon-αn3 (Alferon N)....Pages 191-195 Back Matter....Pages 197-199 This book reviews the main neurobiological, neurophysiological, MRI and clinical features of the early phases of MS. Mechanisms of irreversible axonal damage and the role played by the interaction between glial and axons are highlighted. Contrary to what was thought for a long time the sufficient availability of oligodendrocyte precursor cells to promote remyelination in acute lesions has now been demonstrated. For not understood reasons, remyelination process fails or does not start in many cases, particularly, in the chronic process of the disease. These findings express the importance of the milieu changes induced by inflammatory process in limiting remyelination. Pathological studies demonstrate that in MS destructive processes may be followed by recovering phases in such a way that myelin may be morphologically and functionally reconstructed. This all brings the rationale of early treatments and the results of clinical trials in early MS to the fore as one of the most important questions today Early diagnosis is a new challenge for the neurologist, as demonstrated by the advantages of early treatment of multiple sclerosis with interferon beta. The rationale for early treatment is extensively reviewed together with the mechanism underlying irreversible damage in MS.