Targeting the central nervous system: The future of therapeutic strategies for MS

Abstract

Targeting the central nervous system: The future of therapeutic strategies for MS Tara M. DeSilva from the Department of Neurosciences, Cleveland Clinic, looks at the future of therapeutic strategies for MS, focusing on targeting the central nervous system. Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease initially characterized by white matter lesions in the central nervous system (i.e., brain, spinal cord, and optic nerve) detected by magnetic resonance imaging (MRI). Lesions are caused by the infiltration of immune cells, resulting in loss of the insulation (myelin) around nerve fibers (neuronal axons). Early in the MS disease course, myelin regenerates; however, over time, sustained demyelination results in axonal injury and permanent disability. (1) The location of a lesion in the brain, spinal cord, or optic nerve determines the type of deficit a patient with MS will experience. Most patients with MS initially present with a relapsing-remitting disease course. During this phase, manifestations of clinical deficits indicate a relapse followed by a recovery or remittance of symptoms. Eventually, MS patients enter into a progressive disease course. During the progressive phase, there is no remittance, and symptoms gradually worsen, leading to permanent disability (Fig. 1).