Bernhard HJ Juurlink
Background: The current pharmacotherapies longest in use to treat multiple sclerosis (MS) do not slow progression to disability. The aim of this commentary is to stimulate interest in looking at MS from a new perspective. There is an abundance of evidence that MS is not primarily an autoimmune disease but is a disease where there is first damage to the blood-brain barrier as well as the oligodendrocyte-myelin unit; this damage then elicits an immune response in a subset of people that have an immune system predisposed to attacking myelin-associated antigens. A brief overview is given of the evidence for arterial compliance problems, intracranial compliance problems, venous return problems and hypoperfusion problems in MS.
Conclusions: A rationale is given for the conduction of clinical trials examining the ability of dietary changes, hyperbaric oxygen treatment and approaches to improve venous return as means to ameliorate MS.