Biochemical indicators for neuronal regeneration during intrathecal triamcinolone application in multiple sclerosis.

Abstract

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). Essential characteristics are demyelination, inflammation and neurodegeneration. This process affects the white and grey matter in the CNS. MS patients experience various progression subtypes in association with the cerebral or spinal, acute inflammatory or glial sclerotic lesions (Muller, 2009). Most patients end up in a progressive, smouldering, chronic inflammatory process (Muller, 2009). Current predominantly used 1.5 respectively 3 Tesla MRI with Gadolinium® application visualize the various old and acute lesions. They serve as a biological marker in combination with standardised assessment of brain atrophy, black holes, etc. However, MRI with a stronger magnetic 7 Tesla field with better sensitivity gave hints on an ongoing, acute inflammatory, smouldering process even with Gadolinium® enhancing acute lesions in the brain and the spinal cord in progressive, so-called relapse free MS patients (Muller, 2009; Sinnecker et al., 2012). Additionally, progress of MS is determined with subjective standardised clinical ratings (Sinnecker et al., 2012). Both methods are used for the evaluation of the efficacy of relapse rate reducing drugs. These compounds, i.e., interferons, teriflunamide, glatiramer acetate, fingolimod, fumarate or monoclonal antibodies, preponderantly weaken the malfunction of the peripheral immune system in relapse remitting MS patients. These MS drugs share one common disadvantage. They do not stop progression or improve MS within a framework of a regenerative process. They do not enable reversal of symptoms, for instance functional deficits or spasticity (Muller, 2009).