Multiple sclerosis: neuroimmunologic puzzle

Multiple sclerosis (MS), a chronic disease with a relapsing and remitting course, is the most common neuroimmunologic condition in the United States. The hallmarks of the disease are focal demyelination and inflammation within the central nervous system (CNS). Because histopathologic changes can be identified only at autopsy, attention has been directed at formulating standardized clinical and laboratory procedures to aid in MS diagnosis. Currently, there are no MS-specific clinical or laboratory tests, but detection of abnormality in cerebrospinal fluid (CSF) IgG is important in supporting clinical evidence of disease. A number of other immunologic abnormalities have been recognized in MS, including the presence of T- and B-lymphocytes within the CNS and alterations in circulating suppressor T-lymphocytes. These findings have been interpreted as indicating disturbed immunoregulation associated with a chronic autoimmune response within the CNS. Evidence implicates viral infection in the pathogenesis of MS but the cause of the disease remains unknown.