| Popis: |
For the purpose of clinical therapeutic trials patients with multiple sclerosis (MS) must be divided into remittent and progressive types. Although the former are more difficult to study because of their high rate of spontaneous improvement, any meaningful therapy will have to address this group, where the lesions are still at least symptomatically reversible. Therapy may appear to be ineffective in chronic progressive or chronic stable MS patients because of an increasingly irreversible nature of the white matter lesions in those stages of the disease.The pathology of MS is consistent with diffusion of a myelinoclastic factor from small venules. Cytotoxic antibody, sensitizing antibody for antibody dependent lymphocytotoxic reactions, and macrophages armed with cytophilic antibody all have experimental support. Recent studies of experimental allergic encephalomyelitis (EAE) suggest that demyelinating antibody is directed against cerebral glycolipids. Circulating demyelinating antibody may require a concomitant inflammatory reaction within the central nervous system, perhaps mediated by sensitization of myelin basic protein, before it can cross the blood-brain barrier and reach its target antigen.Preliminary trials of both plasma exchange and lymphocytaphoresis have shown promise in the treatment of MS, and controlled studies are currently underway. |
