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Updated: Jan 28, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Highly active multiple sclerosis: An update
Cindy Díaz1, Luis Alfonso Zarco2, Diego M Rivera3
1Neurological Resident. Department of Neurology, Hospital Universitario San Ignacio, Universidad Javeriana, Bogotá, Colombia.
Abstract:
Multiple sclerosis (MS) is the most prevalent chronic inflammatory disease of the central nervous system (CNS), affecting more than 2 million people worldwide. It is characterized by brain and spinal cord involvement. There are the relapsing remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS) phenotypes. There is a subgroup of RRMS patients who have a more aggressive disease course marked by a rapid accumulation of physical and cognitive deficit, despite treatment with 1 or more disease modifying drugs (DMTs). In the past, this disease phenotype was called "aggressive" MS (AMS); it is now called highly active MS (HAMS). It is generally agreed that the severe nature of this phenotype requires different treatment decisions. Unfortunately, there is no consensus on the definition of AMS or the treatment algorithm. In this article we review HAMS in relation to its definition and the treatments available.
Insights
Highly active multiple sclerosis (HAMS) is an aggressive form of the disease. This review clarifies HAMS definition and available treatments for better patient management.
Area of Science:
- Neurology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic CNS inflammatory disease affecting over 2 million globally.
- MS presents with relapsing remitting (RRMS), primary progressive (PPMS), and secondary progressive (SPMS) phenotypes.
- A subset of RRMS patients exhibits rapid progression despite disease-modifying drugs (DMTs), termed highly active MS (HAMS).
Purpose of the Study:
- To review the definition of highly active MS (HAMS).
- To discuss current treatment strategies for HAMS.
- To address the lack of consensus on HAMS definition and treatment algorithms.
Main Methods:
- Literature review of HAMS definition and treatment.
- Analysis of existing data on aggressive MS phenotypes.
- Synthesis of expert opinions on HAMS management.
Main Results:
- HAMS is characterized by rapid physical and cognitive decline in RRMS patients, even with DMTs.
- Current definitions and treatment algorithms for HAMS lack universal consensus.
- The severe nature of HAMS necessitates distinct therapeutic approaches.
Conclusions:
- Clearer definition and standardized treatment protocols for HAMS are crucial.
- Further research is needed to optimize HAMS management.
- Addressing HAMS is vital for improving outcomes in aggressive MS cases.
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