Neuro-degeneration is the issue that keeps me awake at night.
The existing theory is that axons get de-myelinated by the immune system attacks and begin to degenerate (as they are no longer supported by the myelin). Some re-myelination takes place saving some axons in the RR stage. Eventually, after a period, a sufferer moves into the progressive stage where axons are dying off leading to more and more disability.
So the treatment theory is to focus on the immune attack and in particular inflammation. The CRABs only reduce attacks by 30%, Tysabri by 66%, Campath and Mitoxantrone by 75%ish. In the case of the last two, they appear to provide stabilisation and in some cases reductions in EDSS. So there seems to be some evidence to support the theory that substantiually reducing attacks / inflammation does seem to save axons.
The complication for me is the damage to grey matter - MS was always described as a white matter (myelin) disease. Also PP MS where there are no attacks - axonal degeneration is the main feature from the start.
The question that the researchers have to answer is - Is MS a neuro-degenerative disease and the immune system responds (trying to clean up the damage) OR an inflammatory disease caused by the immune system which leads to neuro-degeneration? This appears to be the key - most research is focussed on the latter. It concerns me that diseases such as Parkinsons and Alzeimers are neuro-degenerative (involving some inflammation) but are not described as auto-immune like MS. But at the end of the day all three result in damage to the brain!
There is much research into neuro-degeneration and neuro-protection. And some neuro-protective drugs are being trialled.
Attached is a link to a UK Professor who is looking at the pathology of MS. She seems to be surprised at the extent of neuro-degeneration in MS. At least the researchers are looking out of the box, but it would be a scandal if the last 50 years of MS research were shown to be a waste of time.
http://www.mssociety.org.uk/research/re ... esiri.html