Bibliothèque de L'IMIST/CNRST

Includes bibliographical references and index.

Cover; Multiple Sclerosis Therapeutics; Title; Copyright; Contents; Contributors; Abbreviations list; Foreword; Preface; 1 Aspects of multiple sclerosis that relate to experimental therapeutics; Disease features relevant to clinical trials; MS pathology is largely subclinical in early MS; Progressive destructive pathology starts early in the disease; Disease manifestations are heterogeneous; Evolution of the MS disease process- the "MS categories"; Disease severity can not be accurately predicted in individuals or groups; Heterogeneity in pathological mechanisms.

Complexities related to measurement tools that impact clinical trialsClinical measures: relapses, physical function, neuropsychological performance (Chapters 6-8); Patient-reported quality of life measures (Chapter8)56; Conventional MRI measures (Chapters 9,11); Current controversies in MS trials; Relapse rate; EDSS; Relevance of MRI lesions; The role of brain atrophy measures in MS trials; Gray matter pathology; Contemporary issues in MS trials; Optimal study designs for primary neuroprotection; Declining disease severity in contemporary MS trials.

Personalized medicine- from trials to patient careObservational and follow-up studies; Post-approval monitoring; References; 2 The pathology of multiple sclerosis; Introduction; Axonal loss in MS; Inflammatory demyelination as a cause of axonal loss; Loss of axons by immune-mediated mechanisms; Loss of myelin-derived trophic support as a cause of axonal loss; Degeneration of chronically demyelinated axons; Can axonal degeneration in MS be prevented?; Pathology of cortical lesions; Decreased inflammation in cortical lesions; Neuronal damage in cortical lesions.

Microglial targeting of neurons in cortical MS lesionsContribution of cortical lesions to neurological disability and neuronal compensation; Functional consequences; Future challenges; Acknowledgments; References; 3 The immunology of multiple sclerosis; Introduction; How firm is the autoimmune hypothesis in MS?; A framework to describe the immunology of MS; Peripheral immune activation and MS attacks; Evidence for involvement of auto-reactive T-cells in MS; Genetic and environmental risk factors implicated in MS immunology.

Autoreactive T-cells may be activated by auto-antigens or by foreign antigens through molecular mimicryT-cell co-stimulation as a therapeutic target (Chapter 41); T-cell differentiation into functionally distinct subsets influences autoimmune disease outcome; Regulatory T-cells and control of autoimmunity; B-cells as important regulators of T-cell responses in MS (Chapter 42); Involvement of the innate immune system in peripheral immune responses; Immune cell invasion into the CNS: more than one route; Impact of immune responses within the CNS; (Re)activation of T-cells within the CNS.

"This book comprehensively reviews the current state of clinical trial methods in multiple sclerosis treatment, providing investigators, sponsors and specialists with current knowledge of outcome measures and study designs for disease and symptom management. The status of the rapidly evolving field of disease-modifying drugs is presented, with emphasis on the most promising therapies currently being tested. Experts discuss disease and symptom management for MS subtypes, including neuromyelitis optica and pediatric MS. In addition, key scientific advances in MS pathology, genetics, immunology and epidemiology are presented. The fourth edition has been extensively revised, featuring more than 50% new material. All chapters have been substantially updated to provide current information on rapidly evolving topics and this volume contains 15 new chapters, reflecting the growth of the field in recent years. This book is an essential reference for practitioners caring for MS patients, investigators planning or conducting clinical trials, and clinical trial sponsors"--Provided by publisher.