A unified view of multiple sclerosis

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frodo
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A unified view of multiple sclerosis

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A unified view of multiple sclerosis

https://www.researchgate.net/profile/Da ... erosis.pdf

Abstract

The clinical course of multiple sclerosis (MS)is highly variable. To establish a standardized terminology, four distinct MS phenotypes were defined in 1996: relapsing-remitting, secondary progressive, progressive relapsing and primary progressive MS.

This scheme was recently revised to include radiologically isolated and clinically isolated syndrome, and two descriptors, activity and progression, to allow for a more nuanced description of phenotypes. On the whole, this classification helps to identify patients who respond to disease-modifying treatment and patients who do not.

However, the distinction between the phenotypes is blurred, as relapsing-remitting patients accrue disability independent of relapse activity. The classification also presents the problems that different disease courses do not correspond to qualitatively distinct pathologies, that it does not account for the substantial variability within MS phenotypes and that progression is a retrospective diagnosis.

We propose a novel view of MS based on active pathomechanisms rather than clinical presentation. We argue that MS is the result of a combination of multiple interconnected, pathological processes that have different degrees of activity in a given patient. These processes are modified by a vast number of genetic, biological and environmental factors, resulting in a continuum of pathological phenotypes and, by extension, clinical presentations.

Monitoring the processes that drive disease activity in a given patient will require a panel of quantitative biomarkers. Development of such a panel should be of high priority, as it would allow for a more precise representation of disease states and improve prognostication, personalized clinical care and clinical trial design.
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