The Multiple Forms of Multiple Sclerosis

Elvin Montanez, Pharm.D., Senior Vice President at BioPlus Specialty Pharmacy

Multiple sclerosis (MS) can be a tough disease to diagnose, since its symptoms can be mistaken for other conditions. Even after this autoimmune disease is ID’ed, that may not be the end of the story. Today, experts are starting to understand that there is more to the story about the types of multiple sclerosis than previously understood.

Back in 1996, international MS experts got together and put out standardized descriptions of the different forms of MS. This was a huge step forward in diagnosing and treating this disease and four forms of MS were identified:

  • Relapsing-remitting MS
  • Primary progressive MS
  • Secondary progressive MS
  • Progressive relapsing MS

A lot has changed since 1996. Not surprisingly, MS experts have taken advantage of new technologies and diagnostic and treatment tools to reexamine the accuracy of MS types. The latest consensus recently released by today’s experts does not completely do away with the 1996 disease descriptions, but rather clarifies and refines what each disease type means. In fleshing out the diagnostic and treatment considerations with the latest understanding of MS, the latest consensus of MS experts note the following five points of consideration:

  1. Progressive relapsing MS (PRMS) is no longer a useful category and should be removed from the diagnostic choices. Instead, patients previously considered to have PRMS are now in the category of primary progressive MS (with disease activity).
  2. A new type of MS is now included: clinically isolated syndrome (CIS). CIS is the first clinical presentation of MS, yet the type of MS is not yet known in these patients. Over time, as the CIS symptoms progress, the patient will be further diagnosed.
  3. It’s crucial for the disease activity to be assessed (based on clinical assessment of relapse occurrence or lesion activity noted in CNS imaging).
  4. It should be determined whether the MS has progressed over a period of time.
  5. Physicians and patients benefit from the use of disease markers (e.g., clinical exacerbations or MRI-detected lesions) and measures of disease progression to better understand each patient’s disease stage and proper treatment.

Patients who, based on these refined diagnostic criteria, find out they have a progressive form of MS, often feel a sense of dread about the future, wondering when and how bad their disease will progress. Fortunately, I have some good news to share about this: the disease in most patients does not progress as often or as rapidly as previously feared.

When a group of patients diagnosed with primary or secondary progressive MS were followed closely for seven years, there was not as much disease progression as might have been expected. Nearly seven out of 10 of the patients did not show significant worsening in their function level (as measured by a disability scale) over the seven years of this study. In addition, when data from a timed 25-foot walk test was available – which is a standard marker of a patient’s functional independence – about half of patients did not have a change in their ability to walk, while just 30% deteriorated in this skill. A small percentage of patients even improved on this test over time.

As new understanding and medications continue to evolve in the treatment field of MS, it’s likely that good news will continue to roll out about this disease.

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Sources

Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology 2014;83:1-9.

Pandeyemail KS, Krieger SC, Farrell C, et al. Clinical course in multiple sclerosis patients presenting with a history of progressive disease. Multiple Sclerosis and Related Disorders 2014;3(1):67-71.

 

 

 

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