[Pathogenesis and treatment of multiple sclerosis (state of the art in 2000)]

Multiple sclerosis is universally accepted to be a multifactorial disease whose pathogenesis is due to a complex of immunopathological and pathochemical reactions. The key assumption is that only early stages of immunopathological chain reactions involve specific recognition of antigens by autoreactive T cells and antibodies. These early events trigger a demyelinating process at whose later stages of importance are macrophages and glial cells, particularly those of microglia, which produce a great deal of biologically active substances and inflammatory mediators. A deeper insight into the pathogenesis of multiple sclerosis has provided new therapeutical approaches to treating this disease. In addition to that there are effective IFN-beta drugs (Betaferon, Rebif, Avonex) and Copaxone, other pathogenetically justified approaches are still under search. The next step of further studies is to identify subtypes of multiple sclerosis and to choose a therapy in accordance with its pathogenetical mechanisms.