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Management of secondary-progressive multiple sclerosis
1Department of Neuroinflammation, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK. g.giovannoni@ion.ucl.ac.uk
CNS Drugs
|July 24, 2004
Summary
Most patients with relapsing multiple sclerosis (MS) develop secondary progressive MS (SPMS). While therapies can stop relapses, they don't halt SPMS progression, highlighting the need for effective symptomatic treatments.
Area of Science:
- Neurology
- Immunology
Background:
- Relapse-onset multiple sclerosis (MS) frequently transitions to secondary progressive MS (SPMS).
- The distinct nature of relapsing versus progressive MS phases and SPMS pathogenesis remain poorly understood.
- The role of inflammation in MS progression is not well-defined.
Purpose of the Study:
- To explore the qualitative differences between relapsing and progressive phases of MS.
- To investigate the underlying pathogenesis of SPMS.
- To clarify the role of inflammation in disease progression.
Main Methods:
- Review of natural history studies on MS progression.
- Analysis of the efficacy of current disease-modifying therapies (DMTs) in SPMS.
- Evaluation of symptomatic treatment strategies for SPMS.
Main Results:
- Immunosuppressive therapies controlling relapses do not typically halt SPMS progression.
- Disease progression in SPMS appears independent of superimposed relapses.
- Poor recovery from relapses contributes to disability accumulation.
Conclusions:
- Stopping relapses may delay disability but not necessarily SPMS onset.
- Current DMTs for SPMS are limited and mainly for patients with ongoing relapses.
- Multidisciplinary symptomatic therapies are crucial for managing SPMS, focusing on neurological function, disability reduction, and quality of life.