Neuroimmunology

This page contains the following information about Neuro-Immunology:

• What is multiple sclerosis (MS)?
• What is CNS vasculitis?
• What is CNS lupus?
• Commonly asked questions and answers

Neuro-immunology involves the study and treatment of immune system diseases and conditions that affect the central nervous system. New York-Presbyterian offers comprehensive care and cutting-edge treatments for people who are diagnosed with the following disorders:

• Multiple sclerosis (MS)
• Vasculitis (primary or secondary to Sjogren's, Wegener's granulomatosis, Polyarteritis nodosa, temporal arteritis)
• Lupus of the central nervous system
• Neurosarcoidosis
• Bechets disease

What is Multiple Sclerosis (MS)?

MS is a chronic disease that causes inflammation in the white matter of the central nervous system and ultimately destroys myelin, which insulates and protects nerve cell fibers in the brain, optic nerve, and spinal cord. Throughout the course of the disease, which usually begins in early adulthood, people with MS experience occasional relapses, called exacerbations, followed by periods of remission. 

Recognizing and diagnosing MS

Symptoms of MS may be mild or severe, and of varying durations. Vision problems, such as blurred or double vision, red-green color distortion, and blindness in one eye are often the first noticeable symptoms. Additional symptoms include muscle weakness in the arms and legs, coordination and balance problems, and occasional numbness or tingling, as well as cognitive impairment such as concentration, memory, and judgment problems.

There is no definitive test for MS. However, a neurologist may conduct a complete medical history and neurological examination to rule out other neurological conditions. Imaging techniques such as computed tomography (CT) scanning or magnetic resonance imaging (MRI) can view the lesions caused by MS. Magnetic resonance spectoscopy (MRS) is another imaging technique that may gather information about the biochemistry of the brain. Laboratory tests that examine the patient's spinal fluid and presence of oligoclonal bands in cerebrospinal fluid also may help diagnose MS.

Treating MS

Currently, there is no cure for MS. MS flares can be treated with short courses of steroids.  In order to prevent relapses, interferon beta (Avonex or Betaseron) or colpaxone can be administered.  In severe cases, immunosupressants such as cyclophosphamide or mitoxantrone can be used.

What is CNS Vasculitis?

Vasculitis is an inflammation of the blood vessels, including veins, arteries, and capillaries. Vasculitis of the central nervous system (CNS) is an autoimmune disorder, in which the body launches an attack against the blood vessels that supply the brain and spinal cord. Inflammation of these blood vessels prevents blood from flowing to parts of the brain and spinal cord, which can result in damage to the CNS.

Recognizing symptoms and diagnosing CNS vasculitis

CNS vasculitis often causes severe headaches and stepwise stroke-like focal symptoms that sometimes even leading to coma.

A definitive diagnosis of CNS vasculitis is only possible with the aid of a brain biopsy. However, doctors can confirm their suspicion with blood tests, examination of the cerebrospinal fluid through a spinal tap (lumbar puncture), magnetic resonance imaging (MRI), and cerebral angiography.

Treating vasculitis

Often times this disease responds to high-dose steroids.  In some cases, chemotherapeutic agents which suppress the immune system are necessary.

Treatment also may require the removal and reinfusion of blood plasma (plasmapheresis) or the use of gammaglobulin.

What is CNS Lupus?

Lupus is a chronic immune-system disorder that produces an abnormal number of antibodies, which launch an attack against the person's own tissues. In some cases, antibodies may attack the organs and blood vessels of the central nervous system (CNS).

Recognizing symptoms and diagnosing CNS lupus

Treating CNS lupus

While there is no cure for lupus, most people with the disorder can significantly reduce symptoms or achieve remission with medications such as aspirin or other non-steroidal anti-inflammatory drugs, antimalarial drugs, steroids, and immunosuppressants, combined with rest, exercise, proper nutrition, and stress management.

Commonly asked questions and answers about MS

What causes MS?
The exact cause of MS is not known, but the disease appears to be caused when the immune system mistakenly recognizes the body's own myelin (the protective sheathing around nerve cells) as a foreign substance.

Do people with MS have a shorter life expectancy?
Most people with MS have a normal life expectancy.

Should a person with MS expect to eventually be incapacitated by the disease?
In some cases, MS can be very debilitating. However, most people with MS can continue to lead a normal life with minimal restrictions on their daily living activities.

Commonly asked questions and answers about Vasculitis

What causes CNS vasculitis?
It is widely believed that the disorder is caused by an autoimmune response, in which the body views its own tissue as foreign and sends antibodies to attack the foreign tissue. It is not known what causes this faulty immune response.

Is this type of vasculitis dangerous or fatal?
When major organ systems, such as the central nervous system, are affected, vasculitis can be a very serious disorder, causing permanent damage.

Can early detection and treatment help the vasculitis patient?
Yes.

Commonly asked questions and answers about CNS lupus

Is CNS lupus fatal?
Not usually. Most people with lupus in one of its various forms have a normal lifespan, with intermittent periods of relapse and remission. It can be fatal in severe cases of lupus cebritis

Can CNS lupus be prevented?
Unfortunately not, but early treatment and detection aids greatly in maintaining quality of life for the average lupus patient.