General introduction

Abstract

Substantial advances in understanding disease processes in multiple sclerosis (MS) have occurred in recent years. Many susceptibility genes have been identified, complex immunological pathways have been mapped out, and rapid changes in imaging techniques have vastly added to our understanding of temporal changes occurring in the disease. Perhaps more significantly, powerful treatments are emerging with dramatic effects on relapse frequency, allowing the clinician an array of therapeutic options. Yet despite these advances, progressive MS remains difficult to treat and, once established, current drug therapies have little influence on the disease course of progressive MS. Patients with progressive disease are often frustrated by the lack of disease-modifying therapies (DMTs) and many will turn to alternative unproven treatments out of desperation. Clinicians too may feel powerless to halt the relentless progression of disability. Having said that, knowledge concerning the disease mechanisms is burgeoning and many research groups are starting to develop strategies to treat disease progression. At the heart of such strategies is an increasing knowledge of the pathophysiology of disease progression. This book will review the current state of knowledge concerning disease progression and put it in the context of developing and future therapies for this particular phase of MS. To set the scene, in this chapter some general features of MS, which will not be covered in subsequent chapters, and some brief recent updates in the broader field of MS will be presented.