Multiple sclerosis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
Classification
Multiple sclerosis may be classified according to clinical course into four groups:[1]
- Relapsing-remitting:
RRMS is defined by acute attacks of neurological dysfunction followed by full or partial recovery. Patient clinical symptoms are stable between the attacks.[1]
- Secondary progressive:
Patient with long term RRMS can switch to SPMS, when the neurological symptoms progressively worsen between the attacks.[1]
- Primary progressive:
PPMS is defined by continuously worsening of neurological dysfunction with no distinct attacks and remissions.
- Progressive relapsing:
- PRMS is defined by progression of disease from the beginning with acute attack episodes.
These subtypes were defined In 1996 by the US National Multiple Sclerosis Society (NMSS).[1]
Nevertheless the earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS). In CIS, there is a subacute attack suggestive of demyelination but the person does not fullfill the criteria for multiple sclerosis.[2] Several studies have shown that starting treatment with interferons during the initial attack can decrease the chance that a patient will develop MS.[3][4][5]
Special cases of the disease with non-standard behavior have also been described although many researchers believe they are different diseases. These cases are sometimes referred to as borderline forms of multiple sclerosis and are Neuromyelitis optica (NMO), Balo concentric sclerosis, Schilder's diffuse sclerosis and Marburg multiple sclerosis.[6]
References
- ↑ 1.0 1.1 1.2 1.3 Lublin FD; Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996 Apr;46(4):907-11. PMID 8780061
- ↑ Miller D, Barkhof F, Montalban X, Thompson A, Filippi M (2005). "Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis". Lancet neurology. 4 (5): 281–8. doi:10.1016/S1474-4422(05)70071-5. PMID 15847841.
- ↑ Jacobs LD; Beck RW; Simon JH; Kinkel RP; Brownscheidle CM; Murray TJ; Simonian NA; Slasor PJ; Sandrock AW. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med 2000 September 28;343(13):898–904. PMID 11006365
- ↑ Comi G; Filippi M; Barkhof F; Durelli L; Edan G; Fernandez O; Hartung H; Seeldrayers P; Sorensen PS; Rovaris M; Martinelli V; Hommes OR.Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study.Lancet 2001 May 19;357(9268):1576–82. PMID 11377645
- ↑ Kappos L, Freedman MS, Polman CH; et al. (2007). "Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study". Lancet. 370 (9585): 389–97. doi:10.1016/S0140-6736(07)61194-5. PMID 17679016.
- ↑ Borderline forms of MS, Fontaine, B., Federation de Neurologie, INSERM U546, Groupe Hospitalier, Faculte de Medecine Pitie-Salpetriere, Paris [1]