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Advanced Neurology Multiple sclerosis: Immunopathogenesis

Median survival 1.0 year (interquartile range [IQR] = 0.7 activity profile could be diagnosed with MS, increasing
– 2.3, range = 0.3 – 6.2) and 0.6 years (IQR = 0.4 – 1.1, the sensitivity and prevalence of MS . The application
[83]
range = 0.3 – 7.5) (P < 0.001). The findings of the study of the 2017 McDonalds criteria increased the frequency
are congruent with the age and the presence of brain of MS diagnoses by an additional 41.7% of patients and
MRI lesions at baseline being the high-risk predictors of categorized 87.7% of patients previously diagnosed with
conversion to MS . CIS as fulfilling the new criteria for RRMS, increasing the
[76]
total RRMS cases to 94.1%, with the rest (5.8%) being CIS
After examining electronic medical records of military [84]
patients, researchers found that the prevalence of ON was patients . The increase in survival rates of MS (excess
mortality decreased from 11.29% to 2.56%) has led to a
8.1/100,000 between 2006 and 2018, and the incidence shift in prevalence toward the elderly population .
[85]
rates were about 3 times higher in women than in men,
which also increased with age . It has been shown that Because of the inclusion of CIS in RRMS, a decrease
[77]
sex hormones, such as estrogen, progesterone, prolactin, in relapse rates and fewer persistent symptoms have
and androgen, and their function in immune system have a been noted. Notably, an increase in milder disease
bearing on the unbalanced development of MS among male progression could be attributed to declining tobacco use
and female individuals. It is thought that the use of oral in Western Europe and North America [12,86] . Despite the
contraceptives, smoking and dietary habits, and tendency fact that current MS diagnostic criteria revisions and
for Western women to have fewer children and also at available diagnostic tools should allow for earlier MS
older maternal age may influence this inequality . There identification, delays seem inevitable. Solomon et al.
[78]
were 136 cases registered after ON eventually converted to conducted a worldwide study to identify the causes of
[87]
MS. In women, the MS probability of conversion was 12% “major barriers” to early MS diagnosis . A total of 107
at 6 months, 18% at 5 years, and 19% at 10 years; in men, it countries participated in this study and completed the
was 8%, 12%, and 14% at 6 months, 5 years, and 10 years, Atlas questionnaire based on MS diagnosis. The 2017
respectively . In Korea, a retrospective study utilizing McDonald criteria were the most commonly used criteria
[77]
data from 2010 to 2016 was conducted . There were 531 for MS diagnosis (84 [79%] countries). Higher-income
[79]
diagnosed pediatric ON cases and 7183 adult ON cases . countries tended to use the 2017 McDonald criteria
[79]
A total of 111 patients presenting with ON as the first more often than lower-income countries (66 [90%] vs.
symptom converted to MS. The cumulative conversion rate 18 [58%], P < 0.001). The majority of countries (83%)
to MS was estimated to be 10.6% in the overall population. showed at least 1 major barrier to early MS diagnosis.
MS conversion rate in the pediatric cohort was 13.8% and The most prevalent causes for the delays of MS diagnosis
were “lack of awareness of MS symptoms among general
11.4% in the adult population .
[79]
public” (68%), “lack of awareness of MS symptoms among
Optical coherence tomography was used to health-care professionals” (59%), and “lack of availability
quantitatively assess the different retinal layers. The results of health-care professionals with knowledge to diagnose
of the study showed that the thickness of the ganglion cell MS” (44%) .
[87]
layer and the inner plexiform layer (GCLIPL) as well as the
peripapillary retinal nerve fiber layer and the inferonasal 6. Association of MS with optic neuritis
sector of the GCLIPL of the contralateral eye predicted At MS, ON presents as the initial manifestation of the
the development of MS with statistical significance disease in 20% of those affected, and about half of those
(hazard ratio [HR] = 0.922, 95% CI = 0.861 – 0.988, patients with MS develop ON later in life . Studies
[88]
P = 0.021; HR = 0.939, 95% CI = 0.891 – 0.989, P = 0.0179; have recorded very low rates of bilateral optic nerve
HR = 0.924, 95% CI = 0.867 – 0.986, P = 0.0172) . involvement in MS (in 427 patients with MS, bilateral
[80]
Changes in diagnostic criteria may provide an answer to ON was diagnosed only in 2 patients [0.42%]) . It
[89]
why milder courses of MS are becoming more common. has been hypothesized that obesity may play a role in
Recently, a new radiological biomarker for inflammatory the development and progression of MS, as well as the
demyelination in radiologically isolated syndrome has treatment response. Several adipocytokines have been
been proposed – an MRI-detectable central vein within suggested, including resistin, leptin, and adiponectin.
white matter lesions [81,82] . According to the most recent These molecules are mediators in the proliferation of T
MS diagnostic guidelines, the McDonalds criteria (2017), cells and the production of pro-inflammatory cytokines,
CIS can be designated as MS if it meets the MRI criteria such as interleukin (IL)-1, IL-6, IL-12, and TNFα, and
for spatial (DIS) and temporal spread (DIT) or DIS is finally the activation of monocytes and macrophages.
[12]
presented with oligoclonal bands in the CSF . This The increase in adipocytokines, with the exception
indicates that more individuals with a lower disease of adiponectin, has been noted in patients with MS,

Volume 2 Issue 3 (2023) 8 https://doi.org/10.36922/an.1319