Meet the editor

Stavros J. Baloyannis, Professor Emeritus of Neurology at Aristotelian University, Thessaloniki, Greece, was born in Thessaloniki. He graduated from the School of Medicine, Aristotelian University. He trained in neurology at Aristotelian University and the Institute of Neurology, London, neuropathology at the Institute of Neurology, London, Catholic University of Louvain, and University of Pennsylvania, neuropathology of auditory pathways

at Harvard University, electron microscopy at the University of Pennsylvania, and neuroimmunology at Yale University. His research includes the blood–brain barrier, mitochondria in Alzheimer's disease, synaptogenesis, neuronal apoptosis, dendritic and synaptic pathology, and Golgi apparatus in dementias. His special interests are neuroethics, neurolinguistics, neurophilosophy, and the history of neurosciences, neurology, and art. He is a member of 60 scientific societies, and an honorary member of the Academy of Hellenic Air Forces, President of the Society for the Amelioration of the Quality of Life in Chronic Neurological Diseases, President of the Orthodox Association for Medical Education and Health in Africa, and visiting professor at Tufts University, Democritus University, Aristotelian University, School of Theology, and School of Philosophy. He is the author of 28 textbooks and 723 papers on neurology and neurosciences. He has organized 26 international congresses and participated in 612 world congresses on neurology, neuropathology, psychiatry, and medical ethics. He is the author of two books of poems. He was head of the Department of Neurology at Aristotelian University (1992–2011) and Director of Research Institute for Alzheimer's Disease.

Contents

**Section 1**

**Section 2**

**Section 3**

**Section 4**

*by Stavros J. Baloyannis*

*and Athena M. Soulika*

*by Joyce Pauline Joseph*

Multiple Sclerosis

Introductory Chapter: Multiple Sclerosis

Myeloid Cells in Multiple Sclerosis

Diagnosis of Multiple Sclerosis

Language Disorders in Multiple Sclerosis *by Majid Soltani and Parvane Rahimifar*

**Preface III**

Introduction **1**

**Chapter 1 3**

Etiopathology **11**

**Chapter 2 13**

Diagnosis **39**

**Chapter 3 41**

Mental Decline in MS **57**

**Chapter 4 59**

**Chapter 5 73**

Neuropsychological Functions and Cognitive Neurorehabilitation in

*by Lambros Messinis, Grigorios Nasios and Panagiotis Papathanasopouos*

*by Marilyn Wang, Sofia Caryotakis, Nagendra Kumar Rai, Alan Nguyen* 

## Contents



Preface

Multiple sclerosis (MS) has for years been a crucial unsolved problem in the field of neurosciences, and is a serious cause of suffering for millions of patients worldwide,

The etiopathological background of the disease, which is presumably a progressive inflammation of the central nervous system (CNS), inducing demyelination in the white matter and degenerative alterations in the gray matter, provoking a multitude of polymorphic clinical phenomena, is still an open field of intensive, constantly

The incidence of MS varies across geographic regions, with high rates in high latitude, affecting three times more women than men at any age. Many genetic factors, major histocompatibility complex and non-major histocompatibility complex, may play an important role in the innate immune mechanisms and in the modulation of the immune system under the influence of the many exterior environmental risk

A large number of patients have from the onset experienced relapses and remissions of various neurological phenomena, lasting for many years, whereas a substantial number of untreated patients face the tragedy of continuous deterioration of their physical and mental condition, resulting in a serious irreversible disability.

Energy failure is the substantial cause of functional impairment in the majority of patients who suffer from MS. That cause is reasonably associated with neuronal degeneration, demyelination, and axonal loss based on a wide spectrum of innate autoimmune mechanisms, inflammatory reactions, mitochondrial dysfunction, cytokine interactions, intracellular and interstitial edema, and perivascular cell reactions.

The clinical manifestations of the disease vary from person to person, from time to time, and from age to age, and most of them are changeable in the majority of the cases even from the initial stages of the disease. Vertigo, nausea, vomiting, hiccups, motor deficits, tremors, dysarthria, cutaneous sensory deficits, sensory phenomena from mucosae, cerebellar dysfunction, gait instability, diplopia, vision impairment, visual field defects, dyschromatopsia, phosphenes, painful conditions, autonomic dysfunction, sphincter insufficiency, fatigue, and cognitive decline, such as episodic memory deficits and impaired visuospacial estimation, emerging early in the disease compose a part of the resizing pattern of the disease. Cognitive decline, which would be attributed to association of gray and white matter lesions, in addition to disconnection and dissociation syndrome, is frequently underestimated in the initial stages of the disease, necessitating neuropsychological evaluation by properly designed tools for MS patients. Cognitive rehabilitation, which is essential for the improvement of the quality of life of patients, may include various methods and techniques enabling patients to overcome common problems of everyday life, coping harmoniously with the disease burden. Language disorders are not rare phenomena in patients who suffer from

affecting psychosomatic homeostasis in the majority of patients.

progressive investigation.

factors and viral infections.

MS, necessitating appropriate speech therapy.

Epstein-Barr Virus in Multiple Sclerosis *by Gulfaraz Khan and Asma Hassani*
