Causes of Delayed Diagnosis Of Multiple Sclerosis in Egypt

Abstract

ultiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS) that is characterized pathologically by inflammation, demyelination, and, ultimately, axonal loss (Frohman et al., 2006; Compston and Coles, 2008). Axonal transection is a consistent pathological feature of acute MS lesions and the incidence of neuronal damage correlates with the extent of inflammation within the lesion. Importantly, such damage may be present in the early stages of MS (Trapp et al., 1999). It can, however, be masked by mechanisms such as recruitment of other neuronal pathways or cortical remodelling, that compensate for functional loss; hence, progressive damage may go unrecognized until it is too late for an intervention to be beneficial (Filippi and Rocca, 2007). As the disease progresses, the balance between degenerative and reparative processes shifts, resulting in progressive neuroaxonal degeneration and increasing disability (Fig. 8) (Ziemssen et al., 2016). Current evidence showing that there is only a limited period early in the course of MS which is critical for maintaining neurological function and preventing subsequent disability ‗windows of opportunity‘. Both early intervention