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Phases and Phenotypes of Multiple Sclerosis.

Orhun H Kantarci

    Continuum (Minneapolis, Minn.)
    |June 5, 2019
    PubMed
    Summary

    Understanding multiple sclerosis (MS) progression reveals distinct phases, from high-risk to progressive stages. Early intervention during the asymptomatic phase may prevent future disability, impacting treatment strategies for MS patients.

    Area of Science:

    • Neurology
    • Immunology
    • Disease Progression

    Background:

    • Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
    • Understanding the dynamic evolution of MS through its distinct phases is crucial for optimizing treatment strategies.

    Observation:

    • MS progresses through three phases: high-risk, relapsing-remitting, and progressive.
    • Subclinical disease activity is increasingly recognized as an integral part of the MS disease course, often preceding clinical symptoms.
    • The distinction between primary and secondary progressive MS is becoming less relevant due to indistinguishable pathology and disease activity.

    Findings:

    • MS phases evolve on a continuum, influenced by aging and early clinical activity.
    • Early, poorly recovered relapses in MS can predict a significantly earlier onset of progressive MS.

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  • Disease-modifying therapies may be most effective when initiated early, potentially during the radiologically isolated syndrome phase.

    • Implications:

    • Interventions to prevent progressive MS should be considered as early as the detection of asymptomatic radiologically isolated syndrome.
    • Ongoing trials are evaluating early treatment approaches with disease-modifying therapies for MS.
    • The benefit of continuing disease-modifying therapy beyond a certain age may be limited, but active disease in younger patients warrants continued treatment.