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Real-world effectiveness often differs significantly from controlled trial results

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Here is what is actually happening

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Conventional thinking posits that a primary defect in adaptive immunity promotes recruitment and entry of peripherally activated lymphocytes into the CNS across a disrupted bloodbrain barrier where a complex cascade of autoimmune/inflammatory processes culminates in edema, and destruction of myelin, axons and oligodendrocytes (for detailed reviews see Dendrou et al., 2015