Progressive MS: Natural evolution in PPMS and SPMS

[frodo]

Pathology and Pathogenesis of Progressive Multiple Sclerosis: Concepts and Controversies

https://pdfs.semanticscholar.org/e4a3/a ... 1d33fa.pdf

Summary

Multiple sclerosis changes not only its clinical appearance, but also
its pathological and pathomechanistic characteristics when transitioning
from the relapsing-remitting phase into the progressive
phase.

While focal lesions of the white matter are predominant in
the RR phase, diffuse changes of gray and white matter determine
the pathology of progressive MS. In this stage, the drivers of the
disease are no longer migrating immune cells from the periphery,
but a chronic inflammatory reaction, which spreads, largely decoupled
from the peripheral immune system, in the damaged central
nervous system.

Therapeutic strategies are therefore particularly
promising if they can curb this inflammatory reaction locally in the
brain and spinal cord or restore the resilience of the structurally and
functionally impaired nervous system