The Yin and Yang of Inflammation in Multiple Sclerosis

  • G. Giovannoni
Part of the Topics in Neuroscience book series (TOPNEURO)


Multiple sclerosis (MS) is a clinically heterogeneous disease [1]. On the one side of the spectrum is relapsing-remitting (RR) disease, characterized by attacks of neurological dysfunction due to focal central nervous system (CNS) inflammation, followed by recovery and a period of remission, and on the other side is primary progressive (PP) disease, which is progressive from the outset with no clinical relapses. Between these two extremes are patients who, after presenting with RR disease, subsequently go onto develop a secondary progressive (SP) course. SP disease can be further subdivided into relapsing and non-relapsing disease, depending on whether or not patients continue to have clinical relapses. Approximately 15%-30% of patients with RR disease do not enter the progressive phase of the disease and are classified retrospectively as having benign disease. Why such clinical heterogeneity occurs is currently unknown. Are RR and PPMS different diseases or are they part of the same clinical spectrum? Why do some patients develop progressive disease whilst others do not? Answers to these questions will not only improve our understanding of MS, but will also have major implications for the treatment of MS. Recent data support a complex role for inflammation in disease pathogenesis, with good and bad effects. This article will review the supporting data and propose a hypothesis to explain this paradox or yin and yang of inflammation.


Nitric Oxide Multiple Sclerosis Experimental Autoimmune Encephalomyelitis Experimental Allergic Encephalomyelitis Clinical Relapse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer-Verlag Italia 2004

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  • G. Giovannoni

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