Progressive Multiple Sclerosis

This article provides an update on progressive forms of multiple sclerosis (MS), with a focus on pathogenic mechanisms, clinical features, imaging features, and recent therapeutic advances.

Progressive forms of MS are identified by a history of progressive accrual of disability independent of relapse, but they share many biological, clinical, and MRI features with relapsing MS. Both relapses and new lesions can occur in the context of progressive MS, and establishing when the transition from relapsing to progressive MS occurs is often difficult. Several pathogenic mechanisms coexist in progressive MS. Targeting inflammation in both primary and secondary progressive MS appears to reduce the accumulation of disability.

Progressive MS remains a diagnostic challenge, and the pathogenesis underlying progression is complex. Significant overlap in the biology and clinical and imaging features of progressive MS exists with relapsing forms of the disease. The use of disease-modifying and symptomatic treatments may improve the quality of life for patients with progressive MS.