Multiple sclerosis


Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system in young adults. This disorder is a heterogeneous, multifactorial, immune-mediated disease that is influenced by both genetic and environmental factors. In most patients, reversible episodes of neurological dysfunction lasting several days or weeks characterize the initial stages of the disease (that is, clinically isolated syndrome and relapsing–remitting MS). Over time, irreversible clinical and cognitive deficits develop. A minority of patients have a progressive disease course from the onset. The pathological hallmark of MS is the formation of demyelinating lesions in the brain and spinal cord, which can be associated with neuro-axonal damage. Focal lesions are thought to be caused by the infiltration of immune cells, including T cells, B cells and myeloid cells, into the central nervous system parenchyma, with associated injury. MS is associated with a substantial burden on society owing to the high cost of the available treatments and poorer employment prospects and job retention for patients and their caregivers.

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Fig. 1: Clinical course of MS.
Fig. 2: Worldwide prevalence of MS.
Fig. 3: Post-mortem histopathological findings in MS.
Fig. 4: Immune system dysregulation within the central nervous system in early and late MS.
Fig. 5: Radiological examples of demyelinating events in MS.
Fig. 6: 2017 McDonald Criteria for demonstration of DIS and DIT in a patient with CIS suggestive of MS.

Change history

  • 22 November 2018

    In the originally published version of this article, in Table 4, Ocrelizumab was incorrectly referred to as an anti-CD25 antibody. This has been corrected in the HTML and PDF versions of the article to an anti-CD20 antibody.


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Nature Reviews Disease Primers thanks M. Amato, R. Gold, H. Lassman and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Introduction (M.F.); Epidemiology (S.V.); Mechanisms/pathophysiology (P.P. and A.B.-O.); Diagnosis, screening and prevention (P.P. and M.A.R.); Management (F.P.); Quality of life (A.S.); Outlook (all authors); Overview of Primer (M.F.).

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Correspondence to Massimo Filippi.

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Competing interests

M.F. is Editor-in-Chief of the Journal of Neurology, has received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis and Teva and receives research support from ARiSLA (Fondazione Italiana di Ricerca per la SLA), Biogen Idec, Fondazione Italiana Sclerosi Multipla, the Italian Ministry of Health, Novartis, Roche and Teva. A.B.-O. has participated as a speaker in meetings sponsored by and received consulting fees and/or grant support from Biogen Idec, Celgene/Receptos, GlaxoSmithKline, Medimmune, Merck/EMD Serono, Novartis, Roche/Genentech and Sanofi-Genzyme. F.P. has received unrestricted academic research grants from Biogen, Genzyme and Novartis, and on behalf of Frederik Piehl, his department has received travel support and/or compensation for lectures and/or participation in advisory boards from Biogen, Genzyme, Merck-Serono, Novartis, Roche and Teva, which have been exclusively used for the support of research activities. P.P. has received speakers honoraria from Biogen Idec, Excemed, Merck-Serono and Novartis. A.S. was a board member of Merck-Serono and Novartis and received speaker honoraria from Almirall, Excemed, Genzyme, Merck-Serono and Teva. S.V. has received consulting and lecturing fees, travel grants and research support from Biogen, Celgene, Genentech, Genzyme, MedDay, Merck-Serono, Novartis, Roche, Sanofi-Aventis and Teva. M.A.R. has received speakers honoraria from Biogen Idec, Genzyme, Merck-Serono, Novartis, Roche, Sanofi-Aventis and Teva and receives research support from the Fondazione Italiana Sclerosi Multipla and the Italian Ministry of Health.

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Filippi, M., Bar-Or, A., Piehl, F. et al. Multiple sclerosis. Nat Rev Dis Primers 4, 43 (2018).

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