Disease is very old and nothing about it has changed. It is we who change as we learn to recognize what was formerly imperceptible.—J. M. Charcot
The cause of multiple sclerosis (MS) and its pathogenesis are unknown, but 2 main theories have emerged: a viral cause and an autoimmune cause. In the past half century, however, research and therapy have been driven by the autoimmune hypothesis. We propose that MS is not an autoimmune disease but a genetically determined disorder characterized by metabolically dependent neurodegeneration.