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The risk of bias was moderate to high using the ROBINS-I tool

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