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Controversies in Neurology |

Multiple Sclerosis Is Not an Autoimmune Disease

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCP; Peter O. Behan, DSc, MD, FRCP, FACP
Arch Neurol. 2004;61(10):1610-1612. doi:10.1001/archneur.61.10.1610.
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The cause of multiple sclerosis (MS) and its pathogenesis are unknown, but 2 main theories have emerged: a viral cause and an autoimmune cause. In the past half century, however, research and therapy have been driven by the autoimmune hypothesis. We propose that MS is not an autoimmune disease but a genetically determined disorder characterized by metabolically dependent neurodegeneration.

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Figure 1.

Immunotherapies in multiple sclerosis. Photopheresis is exposing peripheral blood lymphocytes in extracorporeal circulation to photoactivated 8-methoxypsoralen and reinfusing these cells to “target unirradiated T cells of the same pathogenic clone.” PPD indicates purified protein derivative of the tubercle bacilli.

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Figure 2.

Features suggestive of possible metabolic regulation of disease process in multiple sclerosis. NAA indicates N-acetyl aspartate; MR, magnetic resonance; NAWM, normal-appearing white matter.

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