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Experts Redefine Multiple Sclerosis

Report updates 1996 consensus

Multiple sclerosis (MS) manifests itself in many different ways and takes different courses. A recent effort to fine-tune descriptions — or phenotypes — of MS was undertaken by an international team of leaders in MS research and clinical care. The results were published in Neurology.

“Having better definitions of different types of MS would greatly facilitate research studies, communications between people with MS and their health care providers, and treatment decisions,” said Timothy Coetzee, PhD, of the National Multiple Sclerosis Society.

In 1996 the committee had developed consensus around descriptions of the courses of MS to facilitate research in the disease and to provide researchers and clinicians around the world with a common understanding of the types of MS discussed in publications and in the clinic. This consensus highlighted four courses of MS: relapsing–remitting, secondary progressive, primary progressive, and progressive relapsing. While these descriptions of MS have become well-established, the understanding of MS has advanced, prompting a re-evaluation of the course of MS and of any biological signposts, such as blood markers or imaging, that might help refine these phenotypes.

After searching the medical literature and convening an international workshop, the committee published recommendations that modify prior clinical course descriptions. The committee recommended retaining major courses of MS (i.e., relapsing–remitting, secondary-progressive, and primary progressive) but recommended categorizing progressive relapsing as an active form of primary progressive MS.

Importantly, they recommended that clinicians not just determine a person’s course of MS, but further sub-categorize that course as “active” or “not active” (depending on the presence of clinical relapses or activity on magnetic resonance imaging [MRI] scans) or as progressing (worsening) or not progressing, based on clinical evidence of changes in disability.

“This will provide a truer picture of what an individual experiences,” Coetzee added.

Source: Medical Xpress; June 4, 2014.

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