It's a new day
, so today the idea is that MS is one disease.
I discovered a bit more research on the topic of progression that seems to reinforce the idea that MS is one complex rather than several different diseases.
Age at Disability Milestones in MS
Therefore, prognosis in multiple sclerosis appears, at least to some extent, as age-dependent and not substantially affected by the initial course, be it exacerbating-remitting or progressive. Aside acute focal recurrent inflammation and diffuse chronic neurodegeneration, accelerated ageing-related mechanisms may operate in the central nervous system of multiple sclerosis patients.
My hormone soapbox observation (again) is that several hormone levels (DHEA, estrogen, progesterone and testosterone) decline with age in men and women. IMH non-scientific opinion many of the hormones display significant neuroprotective properties (at least in pre-clinical research), so, I have to ask again, is the transition from RRMS to SPMS in part dependent on declining hormone levels? This research makes me wonder even more.
Another abstract by the same authors on basically the same topic, Natural History of MS: A Unifying Concept
Relapsing-remitting disease can be regarded as multiple sclerosis in which insufficient time has elapsed for the conversion to secondary progression; secondary progressive forms as relapsing-remitting multiple sclerosis that has 'grown older'; and progressive from onset cases as multiple sclerosis 'amputated' from the usual preceding relapsing-remitting phase. Times to reach disability milestones, and ages at which these landmarks are reached, follow a predefined schedule not obviously influenced by relapses, whenever they may occur, or by the initial course of the disease, whatever its phenotype. This leads to a unifying concept of the disease in which primary and secondary progression might be regarded as essentially similar. From the clinical and statistical positions, multiple sclerosis might be considered as one disease with different clinical phenotypes rather than an entity encompassing several distinct diseases--the position of complexity rather than true heterogeneity.
Yet more by the same authors, Accumulation of Irreversible Disability in MS: from Epidemiology to Treatment
There is convincing evidence that neurological relapses in multiple sclerosis (MS) are the clinical counterpart of acute focal inflammation of the central nervous system (CNS) whereas neurological progression is that of chronic diffuse neurodegeneration….
All these observations give support to the fact that relapses do not essentially influence irreversible disability in the long term in MS….
They suggest that MS is as much neurodegenerative as inflammatory, and should cause the modification of disease-modifying therapeutic strategies by focussing on the protection and repair of the nervous system and not only on the control of inflammation.
It’s probably fair to say that these particular researchers see MS as a single disease with neurodegenerative features and that neuroprotection, as you’ve said so often Bromley, should be the focus of new drug development until the cause/cure are identified.
You also said and it sometimes seems to me as well that the research within the last couple of years has left them “without a clue”. They just now seem to be coming to grips with the idea that neurodegeneration may be an integral part of MS and a major contributor to the irreversible disability that may accumulate. I’m still optimistic though since I think physiologically balanced hormone levels may have something to offer vis a vis neuroprotection in the interim. Obviously, that’s just my personal take on it.
I did post info about the development of 17 alpha estradiol (a form of estrogen) for neuroprotection in a number of neurodegenerative diseases that affect men as well as women. Even though MS was not listed, there is one of those terrific EAE studies to suggest it is the 17 alpha receptor that mediates estrogen's neuroprotection in MS
I’m still optimistic for everyone, men and women alike, when it comes to the potential of hormones in the management of MS. I just wish more researchers would take it seriously.