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.
In the last few years, increasing effort has been devoted to better define the characteristics of tissue damage occurring outside MRI-visible lesions in patients with multiple sclerosis (MS) and, as a consequence, to improve our understanding of the disease pathobiology and of the mechanisms leading to the accumulation of irreversible disability. This book provides an updated review of the results obtained by leading research groups in this field. The potential clinical applications of what has been shown so far, as well as the areas for future research in the study of normal-appearing white and gray matter damage in MS are extensively discussed, making this book a valuable tool for clinical neurologists who are involved in the daily-life care of MS patients and for neuroscientists involved in MS research.
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