Autoantibodies as paraclinical markers in multiple sclerosis

Multiple sclerosis (MS) is the most common chronic disabling disease of the central nervous system (CNS) in young adults in Western countries, with a lifetime risk of 1 in 400 and an incidence of 80-110 in 100,000. It is characterised by a profound heterogeneity in clinical expression, prognosis and response to therapies. There are two major clinical subtypes of the disease. Relapsing-remitting (RR)-MS is the more frequent (85%-90%), affecting twice as many women as men. The majority of all RRMS patients go on to develop secondary progressive (SP)-MS at a later stage. The other clinical MS subtype is primary progressive (PP)-MS that is present in 10%-15% of patients who have a disease onset and steady progression. The neuropathological hallmarks of the disease, namely inflammation, demyelination, axonal damage, gliosis and partial remyelination, are not uniformly represented throughout the patient population. Multiple genes contributing to disease susceptibility add further to the complexity of the disease. Although its aetiology and pathogenesis remain controversial, several lines of evidence indicate that MS is mediated by a misdirected immune response against one or several myelin antigens. Another frequently discussed possibility is that the inflammatory reaction is primarily directed against an unknown infectious agent.