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Abstract
Multiple sclerosis (MS) is an inflammatory-mediated demyelinating disease of the human
central nervous system. The clinical disease course is variable, usually starts with
reversible episodes of neurological disability in the third or fourth decade of life,
and transforms into a disease of continuous and irreversible neurological decline
by the sixth or seventh decade. We review data that support neurodegeneration as the
major cause of irreversible neurological disability in MS patients. We question whether
inflammatory demyelination is primary or secondary in the disease process and discuss
the challenges of elucidating the cause of MS and developing therapies that will delay
or prevent the irreversible and progressive neurological decline that most MS patients
endure.