RT Book, Section
A1 Egeberg, Michael D.
A1 Bainbridge, Jacquelyn L.
A1 Clark, Jeffrey K.
A2 Attridge, Rebecca L.
A2 Miller, Monica L.
A2 Moote, Rebecca
A2 Ryan, Laurajo
SR Print(0)
ID 57294528
T1 Chapter 41. Multiple Sclerosis
T2 Internal Medicine: A Guide to Clinical Therapeutics
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-174580-2
LK accesspharmacy.mhmedical.com/content.aspx?aid=57294528
RD 2024/04/20
AB Degradation  of  myelin  sheath  surrounding  axons  in  CNSInflammatory  process  mediated  by  T  &  B  ymphocytes,  antibodies,  macrophages,  &  complement  (N  Engl  J  Med  2006;354:942)  Activated  peripheral  T  cells  activate  matrix  metalloproteinases  →  disrupt  BBB  →  entry  to  CNSCytokines  released  in  CNS  cause  upregulation  of  immune  response  →  damage  to  myelin  sheathCytokines  primarily  involved  in  the  inflammatory  process  include  tumor  necrosis  factor-α,  interferon-γ,  &  interleukins-1,  -2,  -12,  -17,  &  -23  (Ann  Neurol  1994;36:S6)Demyelination  leaves  neurons  vulnerable  to  damage;  if  neurons  severed  →  irreversible;  appears  on  T1-weighted  MRI  as  a  hypointense  lesion  or  “black  hole”  (N  Engl  J  Med  1998;338:278)