The spectrum of multiple sclerosis: new lessons from pathology

This review will focus on recent developments in multiple sclerosis (MS) pathology with particular emphasis on the patterns and mediators of lesion formation in MS, the mechanisms of oligodendrocyte and axon damage and the magnetic resonance imaging-pathological correlation of MS lesions.

The inflammatory cascade in the MS plaque has been characterized in more detail, and other factors such as hypoxia-like injury or excitotoxicity, besides immunological effector mechanisms, have been found to play a role in MS pathogenesis. Cortical demyelination and mechanisms of neuroaxonal damage are discussed in detail. The radiological correlate of basic histopathologic findings is being approached with quantitative methods. Similar quantitative approaches are used in MS-gene expression studies that compare patterns of gene expression in different lesion areas.

These studies will lead to better understanding of the pathogenesis of MS lesions and will hopefully identify new therapeutic targets to modulate inflammation, support remyelination and protect axons and neurons in MS.