Dr F I think the key point we are all hovering around is whether the breach of the BBB is the 'main' reason that 'MS' occurs...
...There needs to be reason to give the dx that isn't challenged and that is why I asked others such as Franz Schelling is the finding of Dawsons Fingers or periventricular lesions the deciding factor.
As Ed pointed out to me the MRI findings of lesions, white spots, hyperintensities are indications of inflammation and not de-myelination so we need a focus point for the 'real' dx of 'MS'. Too many of us have ongoing progression that is related to the disability that is accumulating rather than than the core action that causes 'MS', imo.
I don't think that breach of the BBB is the major cause of MS. It is my opinion that the lesions of MS are a sign of what caused or continues to cause the problem, not the cause of the problem. Although sometimes they do, in most cases the signs, symptoms and lesion locations don't necessarily correlate.
It's hard to disagree with Dr. Schelling on anything related to MS. He should be one of the experts that helps rewrite the definition and diagnostic criteria for MS. While I agree with Dr. Schelling that Dawson's Fingers and periventricular lesions are a deciding factor for classic MS, the problem is that those criteria exclude many patients who have no visible lesions in the brain but have lesions in the cervical cord. These patients typically have greater progression and disability issues. One of the problems is, we still don't have the technology to see all the lesions and pathology so some cases with cervical lesions may have them in the brain but we just don't see them.
Hyperintesity signals aren't necessarily a sign of inflammation. They can also be a sign of edema or they can be a sign of scar tissue due to demyelination or degeneration of the nerve. It takes different scanning techniques and a discerning neurologist to make the determination. Some are too close to tell. On the other hand, it's hard to imagine a case of chronic edema that wouldn't be associated inflammation due to the accumulation of anaerobic and metabolic wastes resulting in immune reactions.