Multiple sclerosis is considered to be an autoimmune, inflammatory disease of the CNS. In most patients, the disease follows a relapsing–remitting course and is characterized by dynamic inflammatory demyelinating lesions in the CNS. Although on the surface multiple sclerosis may appear consistent with a primary autoimmune disease, questions have been raised as to whether inflammation and/or autoimmunity are really at the root of the disease, and it has been proposed that multiple sclerosis might in fact be a degenerative disorder. The authors of this opinion paper argue that multiple sclerosis may be an ‘immunological convolution’ between an underlying primary degenerative disorder and the host’s aberrant immune response. To better understand this disease, they suggest that one should consider non-inflammatory primary progressive multiple sclerosis as the ‘real’ disease, with inflammatory forms reflecting secondary, but very important reactions.
Stys PK, Zamponi GW, van Minnen J and Geurts JJG: Opinion: Will the real multiple sclerosis please stand up? Nature Reviews Neuroscience 13: 507-514 (2012).