Highly active multiple sclerosis - An important, yet inaccurate concept.

Area of Science:

• Neurology
• Immunology
• Clinical Medicine

Background:

• Multiple sclerosis (MS) is a chronic demyelinating disease causing disability in young adults.
• Highly active MS (HA-MS) is a severe phenotype with frequent relapses and high lesion burden.
• Lack of a universal HA-MS definition complicates early diagnosis and treatment.

Purpose of the Study:

• To assess Brazilian neurologists' recognition of HA-MS.
• To evaluate agreement on HA-MS defining characteristics.
• To explore the impact of HA-MS recognition on treatment choices.

Main Methods:

• Cross-sectional online survey distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN).
• Data collected from March to September 2023.
• Statistical analysis using descriptive statistics and chi-square or Fisher's exact tests.

Main Results:

• 206 neurologists responded; 98.1% agreed disease activity influences treatment.
• Annualized relapse rate and gadolinium-enhancing MRI lesions were key indicators.
• Rush et al. definition was favored; high-efficacy therapies (Natalizumab, Ocrelizumab, Alemtuzumab) were preferred.

Conclusions:

• Brazilian neurologists demonstrate consensus in identifying HA-MS clinical and radiological signs.
• There is a preference for early, high-efficacy treatment strategies for HA-MS.
• Standardized criteria are crucial for consistent diagnosis and timely intervention in MS care.