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Multipl Sklerozisin İmmünpatogenezi Kısım 1: Her plak aynı mıdır?

Geçtiğimiz 10 yıl nörolojide nöroimmunolojik hastalıkların giderek ön plana çıktığı bir dönem olmuştur.Özellikle multipl sklerozis, nöromyelitis optika ve limbik ensefalitlerin immünpatogenezi hakkındaki bilgilerçok artmış, söz konusu hastalıkların tanı ve tedavisiyle ilgili yeni tedaviler keşfedilmiştir. Nörolojik ve immünsistem gibi vücudun en karmaşık iki sisteminin hatalı etkileşmesi sonucu oluşan bu hastalıklar tüm nörolojiuzmanlarının meslek hayatları boyunca pek çok kez karşılaşacağı hastalıklardır. Bu hastaların bilinçli birşekilde takiplerinin yapılabilmesi için, nörologların hastalık immünpatogenezleri hakkında bilgi sahibi olma--ları elzemdir. İki kısımdan oluşan bu derlemede, nöroimmünolojik hastalıkların prototipi olan multipl sklero--zisin immünpatogenezi anlatılarak, tıp öğrencilerinin, nöroloji asistan ve uzmanlarının nöroimmünolojibilgilerinin arttırılması hedeflenmiştir. Bu ilk kısımda, multipl skleroz plaklarının histopatolojik özelliklerindenbahsedilerek, MR görüntülemede lezyon yükü çok fazla olan bir kişinin klinik durumu çok iyi olabilirken,neden daha az sayıda lezyonu olan birinin kliniğinin çok daha ağır olabildiği gibi sorulara yanıt aranacaktır.

İmmüpatholegenesis of Multiple Sclerosis Part 1:Are all the plaques the same?

Neuroimmunological disorders came to the forefront in neurology in the past decade. Especially, our knowledge on multiple sclerosis, neuromyelitis optica and limbic encephalitis have massively grown and important diagnostic and therapeutic advances have been made. These disorders arise from the faulty interaction of the two most complex systems of human body: neurological and immune systems. Neurolo- gists will encounter these disorders many times in a life time and they will need an understanding of the immunopathogenesis in order to be able to treat such diseases. In this two-part review, we aim to increase knowledge of medical students, neurology residents and neurologists on neuroimmunology. We will try to do this by explaining immunopathogenesis of the prototypical disorder: multiple sclerosis. In this first part, we will describe the types and histopathological characteristics of multiple sclerosis plaques and try to answer the intriguing question of why some patients with excessive number of lesions are in good clinical condition, while the others with lower plaque load have severe disease.

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