Commentary I

Abstract

The pathophysiology and natural history of multiple sclerosis (MS) have been studied extensively since the mid-nineteenth century, with significant advances in our understanding occurring within the past 20 years. Awareness of the unique cellular and immunologic mechanisms involved in neuron damage, combined with advances in technology that enable more targeted assessment of the pathologic processes, have resulted in a growing understanding of the tissue-destructive mechanisms in MS. This understanding, should allow development of novel and more successful neuron preservation strategies. Ultimately, the goal of chronic disease management, at least in the absence of a cure, is to fine-tune therapeutic approaches and optimize treatment effects and outcomes based on an individual patient's MS characteristics. Certainly, the prevention of accumulated disability is one of the major objectives inherent in this approach, as is the preservation of neuron health through promotion of reparative mechanisms. The first half of this supplement, which includes articles by Lisak,1 Dhib-Jalbut,2 Dutta and Trapp,3 Yong et al.,4 and Loeb,5 aims to provide an understanding of the destructive mechanisms involved, both in MS and in other models of brain pathology. The second half of the supplement deals with the clinical practicalities of trying to assess disease pathology via patient examination and CNS imaging. The supplement begins by discussing potential triggers for neuron damage and the mechanisms of neuron damage and repair, as well as how the field of MS research, and consequently, treatment, has changed in the past decade. It is now clear that tissue destruction in MS is the result of both inflammation-mediated and neurodegenerative processes, although the timing of these processes and their interrelations are still being determined. We know that axonal transection begins earlier in the disease process than previously believed.6 What needs to be determined in much more detail …