Talk:Multiple sclerosis

Defenestration

Defenestration - It's a very minor point, but why was the bit about WNP Barbellion reverted to a line which I'd already informed you was misleading, and bordering on being just plain wrong? Unless you're familiar with the Barbellion diary - and I'm guessing you're not, judging by the wording you used, but if I'm wrong I apologise - then why would you feel the need to tarmac over an edit by someone who is? I know it seems like carping over a very trivial matter but I find it a tiny bit disturbing in the light of your mission to "edit the whole of Wikipedia" as your userinfo claims. Fosse8 14:55, 31 Mar 2004 (UTC)

I'm very, very sorry about that, Fosse8. That was not intentional. I've been working from a copy of the MS article that is saved to my hard drive, and which I was quite sure I had added your change to. Obviously, I was mistaken, and I apologize for that, but I have fixed that now so that future edits will have it included. Defenestration 21:01, 31 Mar 2004 (UTC)

Physio

An anonymous editor requested that physiotherapy is mentioned. It was already in the first paragraph of the "treatment" section. Does anyone have more information about what kind of modalities are used? JFW | T@lk 12:11, 8 Nov 2004 (UTC)

Featured Article

I would like to nominate this article to be a featured article. I was on a lecture about MS today and the article covers that lecture wery well. I'm taking a course about the CNS and traing to become a pharmacist. Bringman

Could you update us on all those new medications used in MS? JFW | T@lk 02:38, 6 Mar 2005 (UTC)

Medications used to treat underlying cause

Thanks to research, there are newer medications available to help treat the underlying causes of multiple sclerosis. While still not a cure, these medications seek to modify the action of the immune system, perhaps even going so far as to destroy one's immune system with the intent of later re-building it. Bone marrow transplant is a strategy which has been used and, to my knowledge, has met with moderate success.

As hopeful as this all sounds, however, it must be emphasized that these treatments are not risk-free. Indeed, Tysabri (Natalizumab), has been withdrawn from use when two patients, who were taking the drug in combination with Avonex, got progressive multifocal leukoencephalopathy (PML), a rare and frequently fatal demyelinating disease. A third case was later discovered in a Crohn's patient who had received 8 doses of Tysabri over an 18-month period and had a prior medication history which included multiple courses of immunosuppressant agents.

As if those of us with MS don't have enough worries about demyelination.

Part of the problem in these new drug therapies is that, too often, people want these drugs available instantly, and without necessarily allowing for data on medium term side-effects to come in. This can result in the emergence of negative side-effects, including premature death, the subsequent outrage from the public and the wholesale call to lengthen the time-to-market for these new drug treatments.

What treats the "underlying cause" of MS, if I may ask? Do you mean methylprednisolone pulse therapy? JFW | T@lk 07:02, 15 Jun 2005 (UTC)

Tysabri is not modafinil. Whig 07:51, 15 Jun 2005 (UTC)

tysabri, modafinil error. thank you for catching that one...

Thanks for getting that. It should have read Tysabri (Natalizumab). I'm glad there are people reading this and catching any errors. Thanks once again!!

"What treats the underlying cause?"

As I am not a neurologist, I cannot render any medical opinion per se nor would I ever presume to do so. However, I do conduct research on multiple sclerosis and my understanding of the mechanism of action of these disease-modifying drugs is that 3 of the 4 commonly known ones modify the action of the immune system cells so that, "...The introduction of interferon beta has had a significant impact on the treatment of MS. Interferon beta occurs naturally and, although its precise mechanism of action is unclear, it is known to have immunomodulatory effects.9 These include inhibition of leucocyte proliferation and antigen presentation, inhibition of T-cell migration across the blood-brain barrier and modulation of cytokine production to produce an anti-inflammatory environment.10"

It is only Glatiramer acetate (Copaxone) which seems to act more as a protein mimic than a pure immuno-modulator. Specifically, "This is a mixture of polypeptides that have been synthesised randomly from a pool of four amino acids - L-glutamic acid, L-alanine, L-lysine and L-tyrosine. Glatiramer acetate was originally designed to mimic myelin basic protein. Its mode of action has not been defined, although it is thought to involve inhibition of lymphocyte migration19 and suppression of T cell activation.20 It may exert its effects by competing with myelin basic protein and perhaps other myelin autoantigens for binding to MHC class II molecules expressed on antigen presenting cells.21"

This is all very well but someone who is living with this less-than-fun illness is probably only slightly less interested in these facts than they are with whether: 1. they will be able to afford the drugs themselves (they are very expensive) 2. these drugs will help patients retain as much ability (and, by inference, independence) for the longest period of time 3. they will be able to cope with the side-effects of the interferon drugs (ie those charming flu-like side-effects 4. they will be able to learn how to self-inject 5. understand that a treatment, regardless of how viable it may be, is still not a cure

At any rate, I thank you for your comments. MS remains of the more mysterious illnesses with still quite a number of questions (qv para 1) and I hope to be able to continue contributing to this article!

Bold textSources Cited:

• From: Multiple sclerosis: the disease and its treatment http://www.pharmj.com/Editorial/20000506/education/multiplesclerosis2.html

9. Weinstock-Guttman B, Ransohoff RM, Kinkel RP, Rudick RA. The interferons: biological effects, mechanisms of action, and use in multiple sclerosis. Ann Neurol 1995;37:7-15.

10. Yong VW, Chabot S, Stuve O, Williams G. Interferon beta in the treatment of multiple sclerosis - mechanisms of action. Neurology 1998;51:682-9.

19. Prat A, Al-Asmi A, Duquette P, Antel JP. Lymphocyte migration and multiple sclerosis: relation with disease course and therapy. Ann Neurol 1999;46:253-6.

20. Miller A, Shapiro S, Gershtein R, Kinarty A, Rawashdeh H, Honigman S, et al. Treatment of multiple sclerosis with copolymer-1 (Copaxone): implicating mechanisms of Th1 to Th2/Th3 immune-deviation. J Neuroimmunol 1998;92:113-21.

21. Arnon R, Sela M, Teitelbaum D. New insights into the mechanism of action of copolymer 1 in experimental allergic encephalomyelitis and multiple sclerosis. J Neurol 1996;243 (Suppl 1):S8-S13.

--209.195.116.126 17:51, 16 Jun 2005 (UTC)

So what is the underlying cause, so that we can treat it? JFW | T@lk 18:32, 16 Jun 2005 (UTC)

Nobody actually knows and that is a large part of the problem! Whig 18:58, 16 Jun 2005 (UTC)

That's what I mean. So let's not pretend that any of those agents treat the underlying cause. JFW | T@lk 19:01, 16 Jun 2005 (UTC)

A useful approach may be found in the thinking of Dr. Leo Galland, M.D. He has made a practice of complicated auto-immune cases, and has subsequently developed protocols that he has written about (search online for him, his Foundation for Integrated Medicine, and/or his articles on Leaky Gut Syndromes).

He breaks down such cases into a cycle of allergic reaction (usually dietary), malnutrition, bacterial disquilibrium, then the resultant strain on liver function and expression of relevant symptoms.

Based on patient lab tests, a physician can ascertain the likely systemic cause of the situation, then goes about an appropriate course of treatment--generally meaning a person first avoids their allergens, then rids themselves of internal problem microgrowth (sometimes with antibiotics), then builds back their immunity, with a basic rotation diet of natural unprocessed food supplemented with vitamins, minerals, amino acids, probiotics, and herbs.

(Galland's credentials include degrees from Harvard, New York University, and training at Bellevue Hospital.) —The preceding unsigned comment was added by —The preceding unsigned comment was added by 4.236.147.18 (talk • contribs) .

Galland's forgotten everything he learned in his fancy training; his theories and practice are unsubstantiated and well outside the accepted practice of mainstream medicine. He is, in short, just another quack. Why? Because that's how he makes lot$ of money. -ikkyu2 (talk) 04:14, 6 March 2006 (UTC)

Except that--like the way science is carried out when it is done correctly--I've seen it work, firsthand. And, of course nowadays, Galland is far from the only finely trained medical doctor who thinks and practices the way he does. The failure of "mainstream" medicine and doctors thus far when it comes to such conditions--as well as your characterization of a colleague who seemingly is a professional threat--speaks more about the field and its fundamentalists than its purportedly helpful information. --Res_q68

underlying causes and medicine...

For what it's worth, I think it is important to differentiate between "treatment" and "cure". While science is still working hard to determine the underlying cause(s) of MS, to state that we ought not to "pretend" that interferon/myelin surface protein mimics treat the underlying cause(s) is, in my mind, premature. We know that immune reaction leading to inflammation results in symptoms even if we are still not completely clear on what triggers the immune system to launch an unwarranted attack. The interferon/myelin surface protein mimics drugs are designed to either modulate the immune reaction or, in the case of Copaxone, divert the immune system so that it attacks it and not the myelin itself. True, these therapies may not treat all of the underlying cause(s) but they do at least seem to work on some aspect of the disease as opposed to treating any of the symptoms themselves (ie Baclofen to help with the excruciating spasticity which is common for many people with MS).

-just me!

Ruth

Unfortunately there is no evidence that the interferons actually reverse, halt or even slow progression, though they seem to reduce the rate of relapses in RRMS. With that said, the side effects are considered by many sufferers to be worse than the disease, and I personally know people who went from partial disability before treatment to permanent disability after treatment. My wife, who has MS, would not even consider the interferons, having suffered briefly from them. Meta-analyses of copaxone have shown no net benefit, either. So we're really at less than nothing with current treatment modalities, unless you consider improved diagnostic "test results" to be more important than actual quality of life with no impact on disease progression. Whig 03:28, 21 Jun 2005 (UTC)

We've found idebenone and hydergine to impart at least some short-term benefit, but I won't claim this to be anything more than a single data point. We're currently looking into low dose natroxene. Whig 03:33, 21 Jun 2005 (UTC)

interferons and interference...

Unfortunately, quite a number of MS patients have found that the side-effects to the meds are worse than the disease itself. Deciding to take any medication for MS is really a "quality of life" one.

My understanding is that the interferons can reduce the progression of disability and the rate of relapse by about 1/3. Does this mean that the underlying causes are being affected? In my own case, it does not matter too much and I'm guessing that for MS patients who are able to tolerate the side-effects, the superordinate goal of maintaining function far outweighs any statistical information regarding treatment of the disease itself.

Yet, I well agree that the interferons are not the panacea that we have come to expect with medical advances. However, they are all we have. It is only now that some data on long term use of the medications for MS are coming in; since it has only been since about 1993 that such drugs have been available.

-Ruth

Ruth, I'm glad if you're experiencing benefit from these medications, and please don't think I'm discouraging you from continuing to use what works for you! Do you take Avonex or Rebif and is your condition relapsing-remitting, secondary-progressive or primary-progressive? Whig 14:55, 21 Jun 2005 (UTC)

Whig: thank you for your support. If you would like to enter into a more personal discussion, please write to me at [email protected]

Work!

We've got it cut out for us, haven't we? After putting out fires for asthma, I really want to give pneumonia the attention it needs to get through FA. But this here is an important article, and it needs our help. It's very lucky to have the all-star team of JFW, KS, WS, DR, Alex, Arcadian, Bip, & PhatRita! Plus I hear there are some wonderful new members ready to help improve the medical parts of The Great Encyclopedia For The People. Awesome! I'm not sure if at the moment I can keep to the MCOTW schedule, but I'll try making my small contribs to MS at some point soon. Does anyone have a general plan of what to do? I can see immediately that refs/EBM needs sorting out, the treatment section needs work, the section on "emotional aspects" needs to be placed in a more suitable spot, probably as a subsection of S&S, history can be moved up front, prevalence needs to be re-titled and edited... Hm. Also, what does everyone think of the ext links? Should we have links to the societies in every country? Maybe folks can post brief suggestions about what they want or would like to do here -- a plan of sorts, as it were -- and we could organize ourselves around that. encephalon 16:35, 7 October 2005 (UTC)

I have added the todo template to the top of this talk page to keep things organised. Add all things you would like to see done there. --WS 17:13, 7 October 2005 (UTC)

For a start I have added all the critics on the FAC page to the todo list. --WS 17:21, 7 October 2005 (UTC)

Tonight I plan to work on the diagnosis and clinical subtypes - I'll be adding references as I go. Does it work best to designate sections or does everyone usually just work separately? I'm going to have a lot of time over the weekend - we should be able to really fix up this article. InvictaHOG 18:03, 7 October 2005 (UTC)

I ended up making more red links. I'll write them, I promise! I rewrote with references the diagnosis section. There were several incorrect statements (nerve conduction velocities, etc.) that I dropped and I thought it was important to acknowledge up front that it is often difficult to diagnose early on. Tomorrow I'll try to tackle the subtypes and medications InvictaHOG 03:45, 8 October 2005 (UTC)

I fixed some red links, made pages for Uhthoff's phenomenon, MOG, MBP. Restructured the treatments section - does anyone feel strongly that we need to keep naltrexone? Doesn't seem to be much data to support it. I expanded signs and symptoms and rewrote the subtypes and triggers. There were several listed triggers which I did not find data for or found contradicting data for - let me know if you had a source I did not reference! Tomorrow I will work on pathophysiology and try to incorporate some of the more recent theories. Hopefully clear up a few more red links...InvictaHOG 03:51, 9 October 2005 (UTC)

Finished some restructuring of pathophysiology, history, prognosis. Epidemiology could still use some work. I'm not sure what to add to the lead - it seems fairly complete at this point. An image would be nice up front, but I don't really have any ideas what we'd show unless we wanted an MRI or something. The references are in place - there can always be more, but I tried to just include ones that were important or addressed potentially contentious issues. There are still two red links that I'll write tomorrow. Rewster is doing a good job of cleaning up the jargon and tightening the language. InvictaHOG 04:39, 10 October 2005 (UTC)

An MRI image would be a great addition. Rewster 05:59, 10 October 2005 (UTC)

Kudos to InvictaHOG for some great improvements. It's a good article; I know I'm learning a lot by working on it! The treatment section should probably have some more input from those outside the US. We shouldn't need to wikify drug brand names, since they should be redirects to the generic name. I'll try to take a look at the prognosis, epidemiology, history and lead sections in a couple of days. Rewster 07:22, 10 October 2005 (UTC)

InvictaHOG, you did some great work this weekend! For the lead, I think an image like figure 2 on this page would be nice. --WS 13:14, 10 October 2005 (UTC)

I'm still new to the image rules. Would the image here be desirable and/or fair use? [1]

A couple of things have been mentioned that we should talk about. I have been following the template listed under clinical medicine, but note that encephalon mentioned moving the history section up, which I have not done. Also, Rewster seemed to think that the Th1/Th2 discussion didn't belong where it is (or ?anywhere). In any event, I put it back in and thought we could discuss whether it's important (it's on the to do list, was in the last discussion, and certainly seems reasonable to me to leave it in) InvictaHOG 10:22, 11 October 2005 (UTC)

I wouldn't move the history section up, I think it is fine where it is now. About the th1/th2, I am curious why rewster wants it removed. --WS 11:04, 11 October 2005 (UTC)

It just needed to be more understandable. I think it is clear now. Thanks. Rewster 06:46, 12 October 2005 (UTC)

Oh, and I don't think the lead is too short, anyone who disagrees? (was mentioned on the featured article candidate page) --WS 11:06, 11 October 2005 (UTC)

I agree about the lead - it's almost twice as long as when we started, though. It could be snappier, but I've never been able to edit my own words effectively. I've added an image which I think might work, let me know what ya'll think! InvictaHOG 21:32, 11 October 2005 (UTC)

Nice image. Nothing left on the todo list... :-) Time to resubmit it for featured article? --WS 21:44, 11 October 2005 (UTC)

Sounds good - but I'd love to let Rewster have a chance to go over the rest of the article. He/she/it (He) has a good eye for jargon and made my prose so much better in the other categories. Also, I went to the new link to the Multiple Solutions...I'm new to wikipedia, but it seems like a bit of an advertisement. Any thoughts on keeping the link/page? InvictaHOG 01:39, 12 October 2005 (UTC)

I suggest everyone carefully review the lead section for completeness, clarity, and effective phrasing, since that's what will show on the Main Page. Otherwise I think it's ready for resubmission. Rewster 06:46, 12 October 2005 (UTC)

Great work on the editing. It really flows now! InvictaHOG 12:27, 12 October 2005 (UTC)

Done. It is now a featured article candidate. Also removed the multiple soltuions link. I don't know if it is spam, but I don't think it is notable here. --WS 10:52, 12 October 2005 (UTC)

HOLY crap!! That was fast! Man, you guys are good. Am very proud of the three of you. An award is in order for Invicta and Rewster; Wouter you've already got one of my world famous, prestigious awards, so I'll have to think of one the inferior Wikipedia ones for you this time :) encephalon 16:37, 16 October 2005 (UTC)

Disease course and clinical subtypes

Just a little point. The figure in this section doesn't appear to tie exactly to the text. The first category described actually has two subplots in the figure relating to it ("benign" and "relapsing-remitting"). And the final one ("progressive relapsing") has no subplot describing it. I'd edit myself if I knew the first thing about MS. Cheers, --Plumbago 09:09, 18 November 2005 (UTC)

Protect?

I might suggest protecting this page. It seems popular with vandals.Bjones 19:09, 18 November 2005 (UTC)

No - see user:Raul654/protection Raul654 19:16, 18 November 2005 (UTC)

Point taken.Bjones 19:21, 18 November 2005 (UTC)

Sylvia Browne

A user added a link to a blog by a Sylvia Browne, who has multiple sclerosis, apparently a famous person with MS and currently in the news. I don't feel the link to be appropriate to the article: in the first place, it does not contain information about MS but instead is a web log about her life experiences. Further, I don't believe she is sufficiently notable or newsworth (she does not appear to be the Sylvia Browne we have an article for; perhaps she has been featured in some local newspaper?). I'm removing the link again, as it seems pretty obvious to me that it doesn't belong, but I'd appreciate comments from anyone else on the appropriateness of its inclusion. User:Cashew, providing some sources of her notability (perhaps links to the news items you mentioned) might help, although I'd still be inclined to not include this link. — Knowledge Seeker দ 08:11, 3 December 2005 (UTC)

I agree that it adds little to the article. Many people with MS give birth. It's not even a particularly well-written blog. InvictaHOG 10:45, 3 December 2005 (UTC)

I agree with KnowledgeSeeker, and don't think a blog of this type belongs. If the user wants this type of thing put out there, I think it would me more appropriate to contact the MS Societies themselves and request links be added to their site(s). The content of a blog like this may be valuable, but I feel it is too subjective for a link from Wikipedia and does not represent a solid resource. RickyWiki December 3, 2005

Blogs are only useful as sources if the blogger is independently notable or if the blog itself has achieved a degree of notability/notoriety. JFW | T@lk 22:24, 3 December 2005 (UTC)

Deleted text

This text was recently added and then deleted. It shoud be cleaned up, wikified and re-added. ≈ jossi ≈ t • @ 23:15, 26 December 2005 (UTC)

Cognitive Impairment in Multiple Sclerosis

Approximately one-half of persons with MS experience some degree of cognitive impairment. Of the MS patients with cognitive dysfunction, most (80 percent) exhibit relatively mild symptoms such as difficulties remembering lists of food items to buy in the supermarket or performing tasks in distracting environments. Most patients can learn ways to compensate for these nuisance symptoms (see below). The remaining 20 percent experience more serious cognitive problems that may interfere with their ability to work and engage in everyday activities such as cooking and driving. I have seen this fairly frequently in my practice and wanted to include it here.

Many factors can cause cognitive impairment. Stress, anxiety, and depression can decrease our ability to remember, pay attention, and solve problems. Similar impairments can occur as a side effect of some types of medications. In MS the cause of cognitive dysfunction is directly related to changes that occur in the brain. MS produces lesions in the white matter of the brain. These lesions affect the way electrical impulses are transmitted across nerve cells. Almost all patients with MS have some brain lesions on MRI scans. Research has shown that the degree and type of cognitive impairment observed in MS patients is related to the amount and location of the lesions in the brain. Thus patients with a small number of lesions may not experience any cognitive dysfunction, whereas persons with a large number of lesions are at high risk for experiencing cognitive problems.

For most patients with MS-related cognitive impairment, the deficits are mild and do not necessarily progress for long periods of time, if at all. In contrast to AD, persons with MS can store new memories and are capable of learning new information, but have problems spontaneously retrieving this information. MS patients are capable of benefiting from reminders and visual aids. It is very rare for an MS patient to have language or communication problems.

I totally agree - I've put on note on the author's page and invited resubmission with references. The style is not a problem (can be copyedited) but it needs referencing. InvictaHOG 23:20, 26 December 2005 (UTC)

I deleted it. Agree that the copyediting is easily done, that the contribution is worthwhile, and that it needs referencing. Not sure it should be re-added; the article's nearly twice the recommended size already. Belongs somewhere, though, it's an important and often neglected topic. -Ikkyu2 23:57, 26 December 2005 (UTC)

Research

I would like to add a reference to current research in MS (and all the other diseases in Wikipedia, actually). It might have a direct impact on the communication with clinical researchers in for the patients, who I know to be referred to the Wikipedia pages already today. It might be psychologically nice for the patients to know that they are not forgotten, too. steffen

All the topics mentioned in the article are under active research. What kind of research would you like? The next treatment? Don't hold your breath - new treatments develop very slowly. JFW | T@lk 23:56, 6 March 2006 (UTC)

Encephalomyelitis disseminata

"Encephalomyelitis disseminata", which is a synonym for multiple sclerosis, had its own little stub. There is no need to have a separate article for a synonym, so that article now redirects here. Below is the content that was there. I am not sure how to best merge it into this article, so if someone can figure it out, here it is:

Encephalomyelitis disseminata is a synonym for multiple sclerosis, an autoimmune disorder of the central nervous system.

Etymology: "Encephalon" is Greek and means "brain", "myelon" is also Greek and means "spinal cord". The ending "-itis" indicates an inflammatory disease. "Disseminata" is Latin (derived from the verb "disseminare", i.e. to broadcast, disseminate) and indicates that inflammation occurs at more than one place within the central nervous system.

--Ezeu 08:51, 21 January 2006 (UTC)

This is a tricky business. Pediatric neurologists refer (in English) to ADEM (acute disseminated encephalomyelitis), which is something that mainly affects children, and can be a single event, often preceded by a viral illness. Proponents of the term argue that the post-viral pediatric syndrome of a single demyelinating attack is a distinct clinical entity from multiple sclerosis, and they cite multiple reasons, including the fact that its epidemiology differs greatly. Its pathophysiology may differ too. So completely nuking the other article may not necessarily have been the right answer. -Ikkyu2 20:17, 22 January 2006 (UTC)

I was personally not familiar with the term Encephalomyelitis disseminata but a pubmed search seems to agree that it is a synonym for MS. It could be added to the list of synonyms in the intro and probably end there. It's certainly separate from ADEM, which has its own article. InvictaHOG 00:34, 23 January 2006 (UTC)

I just read an article in New Scientist (16/11/2002, pp. 12-3) which refers to an article in the Journal of the Royal College of Physicians of Edinburgh ([2]) calling into question the idée reçue that MS is an autoimmune disease. I don't know what has happened on this score in the last three years. They do make a distinction between MS and ADEM--they say the latter is treatable by normal immunotherapy.

Does anyone know anything more about this other theory? Should it be mentioned in the article?

EricK 15:28, 13 February 2006 (UTC)

New section moved from main article; needs cleanup

Pathological subtypes of the disease

The national multiple sclerosis center launched five years ago "The lesion project". This is a project oriented to describe as accurately as possible the MS lessions in order to develop an accurate model of the evolution of the disease.

Claudia Luccinetti, neurologist at the Mayo clinic has been appointed as director of this project. Four different damage patterns have been identified by her team in the scars of the brain tissue:

• Pattern I

The scar presents T-cells and macrophages around blood vessels, with preservation of oligodendrocytes, but no signs of complement system activation.

• Pattern II

The scar presents T-cells and macrophages around blood vessels, with preservation of oligodendrocytes, as before, but also signs of complement system activation can be found.

• Pattern III

The scars are difused with inflamation, distal oligodendrogliopathy and microglial activation. There is also lost of myelin associated glicoprotein (MAG). The scars do not surround the blood vessels, and in fact, a rim of preserved myelin appears around the vessels. There is evidence of partial remielinization and oligodendrocyte apoptosis.

• Pattern IV

The scar presents sharp borders and oligodendrocyte degeneration, with a rim of normal appearing white matter. Lack of oligodendrocytes in the center of the scar. There is no complement activation or MAG loss.

The complement is the part of the inmune system that recognizes an antigen, and its activation is the only difference between the first and second patterns. There is an explanation about how complement works here:

http://immserv1.path.cam.ac.uk/~immuno/part1/lec10/lec10_97.html

The meaning of this fact (heterogeneity of the scars) is controversial. For some investigation teams it means that MS is a heterogeneus disease. Other teams maintain that the shape of the scars can change from one type to other and this could be a marker of the disease action time.

No relationship between these patterns and the clinical subtypes has been stablished by now.

Turmeric

I noticed in the article:

 http://en.wikipedia.org/wiki/Blood-brain_barrier#Multiple_sclerosis_.28MS.29

some speculation about the nature of MS and the effect of turmeric on it, none of which is mentioned on the MS page. Can someone who knows what they're talking about, review this & perhaps add a comment to the MS page?

There's one pubmed review which mentions that the spice affects a pathway commonly awry in MS. Sounds like speculation based on preliminary data. It would make far more sense to excise that from the BBB article than to include it here! InvictaHOG 11:58, 2 May 2006 (UTC)