Inflammation versus neurodegeneration: consequences for treatment.

Inflammation is assumed to be the main driver of neurodegeneration in multiple sclerosis. However there is evidence that questions this hypothesis: Data from pathological studies and from imaging have shown that neuronal/axonal damage occurs early in lesion formation and at the earliest clinical stage of the disease. Additionally axonal damage itself can lead to inflammation and laboratory and clinical observations suggest that inflammation may be neuroprotective. Finally, clinical trials reveal that immunosuppression does not have the predicted effect on axonal damage and disability. Clearly if inflammation is not the primary event but a secondary phenomenon this has important implications in developing treatment regimes.