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Exacerbations, activity, and progression in multiple sclerosis

C M Poser

    Archives of Neurology
    |August 1, 1980
    PubMed
    Summary
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    Evoked response studies reveal asymptomatic lesions in multiple sclerosis (MS), challenging the traditional view of disease onset and activity. Recurrent symptoms, not new ones, dominate exacerbations, highlighting physiological factors in MS progression.

    Area of Science:

    • Neuroscience
    • Neurology
    • Clinical Medicine

    Background:

    • Evoked response studies have identified asymptomatic lesions in multiple sclerosis (MS).
    • The presence of these lesions raises questions about the true onset and activity of MS.
    • Clinical exacerbations in MS often involve recurrence of previous symptoms rather than new ones.

    Purpose of the Study:

    • To investigate the relationship between asymptomatic lesions, disease onset, and disease activity in multiple sclerosis.
    • To explore the role of physiological and psychophysiological alterations in the clinical course of MS.
    • To question the conventional correlation between clinical symptoms and demonstrable disease activity in MS.

    Main Methods:

    • Utilizing evoked response studies to detect subclinical neurological changes.

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  • Analyzing patterns of clinical exacerbations, focusing on symptom recurrence versus new symptom presentation.
  • Correlating imaging findings (radionuclide and contrast-enhanced CT scans) with patient signs and symptoms.

    • Main Results:

    • Asymptomatic lesions are detectable in MS patients through evoked response studies.
    • Physiological and psychophysiological factors significantly influence the clinical presentation of MS exacerbations.
    • A weak anatomical correlation exists between active disease areas shown on scans and the patient's reported symptoms.

    Conclusions:

    • The onset and activity of MS may be better understood by considering subclinical findings and physiological alterations.
    • Clinical symptoms alone may not accurately reflect the underlying disease activity in MS.
    • Subtle metabolic changes in a vulnerable nervous system could contribute to symptomatic progression in MS.