"Multiple sclerosis plus": frontiers between multiple sclerosis and a new nosological entity

Introduction.-Multiple sclerosis (MS) is an inflammatory demyelinating and probably autoimmune disease affecting the white matter of the central nervo us system (CNS). Due to the absence of specific clinical and laboratory mar kers, diagnosis remains difficult Current knowledge and key points.-In particular, no clinical or paraclinica l investigation is satisfactory to distinguish definite MS from other autoi mmune or inflammatory diseases, especially when they predominantly affect t he CNS. Moreover, previous studies have reported that patients with definit e MS could present clinical systemic signs suggestive of other inflammatory or autoimmune diseases, and that MS could be associated with other autoimm une diseases. On the other hand, the presence of biological autoimmune abno rmalities, including antinuclear antibodies and antiphospholipid antibodies , has been observed, with a high frequency in patients with MS in compariso n to control populations. These clinical and laboratory features could ther efore represent a new nosological entity characterized by a systemic immune dysregulation more extensive than the CSN target, or a distinct subgroup o f MS patients with a classical course of the disease. Because of the impact of the new therapeutic approach to MS, an important issue concerning this aspect that should be addressed is the use of immunomodulatory therapy, esp ecially with interferon beta. It appears necessary to consider these abnorm alities before treating MS patients with preventive therapy, in particular in the perspective of new strategies, such as treatment at an early stage o f the disease or combination therapies. (C) 2000 Editions scientifiques et medicales Elsevier SAS.