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Multiple sclerosis (MS) clinical courses are updated, adding clinically isolated syndrome and removing progressive relapsing MS. New classifications consider disease activity and progression for better patient management.

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Area of Science:

  • Neurology
  • Immunology
  • Clinical Medicine

Background:

  • Established 1996 multiple sclerosis (MS) phenotypes included relapsing-remitting, primary progressive, secondary progressive, and progressive relapsing.
  • Advances in understanding MS pathology necessitated a re-evaluation of these clinical classifications.
  • This work presents the main recommendations from the 2013 revisions to MS clinical course descriptions.

Purpose of the Study:

  • To update the clinical course classifications for multiple sclerosis.
  • To introduce standardized terminology for describing MS disease activity and progression.
  • To provide a framework for improved communication, prognostication, and clinical trial design in MS.

Main Methods:

  • Review and synthesis of recommendations from the 2013 MS clinical course revisions.
  • Definition of new criteria for categorizing MS phenotypes.
  • Establishment of terminology for disease activity and progression.

Main Results:

  • Clinically isolated syndrome is now recognized as a distinct clinical course.
  • Progressive relapsing MS has been eliminated as a separate category.
  • All MS forms are subcategorized into active or non-active, based on relapses and MRI findings (T2 or gadolinium-enhancing lesions).
  • Progressive MS is further classified into stable or progressing disability.
  • Specific terminology is recommended: 'worsening' for general advancement, 'disease progression' for true advancement in progressive MS, and caution advised with 'benign'.

Conclusions:

  • Updated MS phenotype characterizations incorporate disease activity and progression metrics.
  • Accurate clinical course descriptions enhance communication, prognostication, and clinical trial design.
  • Revised classifications aid in guiding everyday clinical decision-making for multiple sclerosis patients.