Multiple sclerosis classification: Difference between revisions

	Multiple sclerosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Multiple sclerosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography or Ultrasound
CT Scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Alternative Therapies
Primary Prevention
Secondary Prevention
Tertiary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Multiple sclerosis classification On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Multiple sclerosis classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Multiple sclerosis classification
CDC on Multiple sclerosis classification
Multiple sclerosis classification in the news
Blogs on Multiple sclerosis classification
Directions to Hospitals Treating Multiple sclerosis
Risk calculators and risk factors for Multiple sclerosis classification

VisualWikitext

Latest revision as of 22:47, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Multiple sclerosis may be classified into four groups according to the clinical course of the disease. This includes relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing.

Classification

Multiple sclerosis may be classified according to its clinical course into four groups:^[1]^[2]
In 1996, US National Multiple Sclerosis Society (NMSS) defined multiple sclerosis subtypes according to clinical manifestations.
The fact that the clinical course of the disease is a dynamic process makes it possible that the subtypes switch to each other over time.

Subtypes	Explanation
Relapsing remitting	Relapsing-remitting multiple sclerosis (RRMS) is defined by acute attacks of neurological dysfunction followed by full or partial recovery. Patient clinical symptoms are stable between the attacks
Secondary progressive	Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the neurological symptoms progressively worsen between the attacks
Primary progressive	Primary progressive multiple sclerosis (PPMS) is defined by continuously worsening of neurological dysfunction with no distinct attacks and remissions
Progressive relapsing	Progressive relapsing multiple sclerosis (PRMS) is defined by progression of disease from the beginning with acute attack episodes

Other new multiple sclerosis subclasses

In recent studies a new subtype of multiple sclerosis was defined as "clinically isolated syndrome (CIS)." It is when the clinical presentation of a disease is suggestive of myelin sheath inflammation but cannot fulfill the diagnostic criteria of MS.^[2]^[3]

Another associated termination regarding MS classification is "radiologically isolated syndrome (RIS)." It defines as radiological findings of myelin sheath inflammation without any sign or symptoms in patient. RIS can be an indicator of early stages of MS disease, but it's not a subgroup of MS because radiological finding of inflammatory demyelination without any sign or symptoms of the disease is nonspecific.^[2]

References

↑ 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
↑ ^2.0 ^2.1 ^2.2 Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, Wolinsky JS, Balcer LJ, Banwell B, Barkhof F, Bebo B, Calabresi PA, Clanet M, Comi G, Fox RJ, Freedman MS, Goodman AD, Inglese M, Kappos L, Kieseier BC, Lincoln JA, Lubetzki C, Miller AE, Montalban X, O'Connor PW, Petkau J, Pozzilli C, Rudick RA, Sormani MP, Stüve O, Waubant E, Polman CH (2014). "Defining the clinical course of multiple sclerosis: the 2013 revisions". Neurology. 83 (3): 278–86. doi:10.1212/WNL.0000000000000560. PMC 4117366. PMID 24871874.
↑ Katz Sand I (2015). "Classification, diagnosis, and differential diagnosis of multiple sclerosis". Curr. Opin. Neurol. 28 (3): 193–205. doi:10.1097/WCO.0000000000000206. PMID 25887774.

Template:WH Template:WS

[:0-1] 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

[pmid24871874-2] 2.0 ^2.1 ^2.2 Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, Wolinsky JS, Balcer LJ, Banwell B, Barkhof F, Bebo B, Calabresi PA, Clanet M, Comi G, Fox RJ, Freedman MS, Goodman AD, Inglese M, Kappos L, Kieseier BC, Lincoln JA, Lubetzki C, Miller AE, Montalban X, O'Connor PW, Petkau J, Pozzilli C, Rudick RA, Sormani MP, Stüve O, Waubant E, Polman CH (2014). "Defining the clinical course of multiple sclerosis: the 2013 revisions". Neurology. 83 (3): 278–86. doi:10.1212/WNL.0000000000000560. PMC 4117366. PMID 24871874.

[pmid25887774-3] Katz Sand I (2015). "Classification, diagnosis, and differential diagnosis of multiple sclerosis". Curr. Opin. Neurol. 28 (3): 193–205. doi:10.1097/WCO.0000000000000206. PMID 25887774.

[1]

[2]

[3]

@@ Line 2: / Line 2: @@
 {{Template:Multiple sclerosis}}
-{{CMG}}
+{{CMG}}; {{AE}} {{Fs}}
 ==Overview==
+Multiple sclerosis may be classified into four groups according to the [[clinical]] course of the [[disease]]. This includes relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing.
 ==Classification==
+* Multiple sclerosis may be classified according to its [[clinical]] course into four groups:<ref name=":0">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</ref><ref name="pmid24871874" />
+* In 1996, [[National Multiple Sclerosis Society|US National Multiple Sclerosis Society]] (NMSS) defined multiple sclerosis subtypes according to [[History and Physical examination|clinical manifestations]].
+* The fact that the [[clinical]] course of the [[disease]] is a dynamic process makes it possible that the subtypes switch to each other over time.
+{|
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtypes
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Explanation
+|-
+! style="background: #DCDCDC; text-align: center;" |'''Relapsing remitting'''
+| style="background: #F5F5F5;" |
+* Relapsing-remitting multiple sclerosis (RRMS) is defined by acute attacks of [[neurological]] [[dysfunction]] followed by full or partial [[recovery]]. Patient [[History and Physical examination|clinical symptoms]] are stable between the attacks
+|-
+! style="background: #DCDCDC; text-align: center;" |'''Secondary progressive'''
+| style="background: #F5F5F5;" |
+* Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the [[neurological]] [[symptoms]] progressively worsen between the attacks
+|-
+! style="background: #DCDCDC; text-align: center;" |'''Primary progressive'''
+| style="background: #F5F5F5;" |
+* Primary progressive multiple sclerosis (PPMS) is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks and [[remission]]<nowiki/>s
+|-
+! style="background: #DCDCDC; text-align: center;" |'''Progressive relapsing'''
+| style="background: #F5F5F5;" |
+* Progressive relapsing multiple sclerosis (PRMS) is defined by progression of [[disease]] from the beginning with acute attack episodes
+|}
-Multiple sclerosis may be classified according to clinical course into four groups:<ref name=":0">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</ref>
+=== Other new multiple sclerosis subclasses ===
+* In recent studies a new subtype of multiple sclerosis was defined as "clinically isolated syndrome '''('''CIS''')'''." It is when the [[clinical]] presentation of a [[disease]] is suggestive of [[myelin sheath]] [[inflammation]] but cannot fulfill the [[diagnostic criteria]] of [[MS]].<ref name="pmid24871874">{{cite journal |vauthors=Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, Wolinsky JS, Balcer LJ, Banwell B, Barkhof F, Bebo B, Calabresi PA, Clanet M, Comi G, Fox RJ, Freedman MS, Goodman AD, Inglese M, Kappos L, Kieseier BC, Lincoln JA, Lubetzki C, Miller AE, Montalban X, O'Connor PW, Petkau J, Pozzilli C, Rudick RA, Sormani MP, Stüve O, Waubant E, Polman CH |title=Defining the clinical course of multiple sclerosis: the 2013 revisions |journal=Neurology |volume=83 |issue=3 |pages=278–86 |year=2014 |pmid=24871874 |pmc=4117366 |doi=10.1212/WNL.0000000000000560 |url=}}</ref><ref name="pmid25887774">{{cite journal |vauthors=Katz Sand I |title=Classification, diagnosis, and differential diagnosis of multiple sclerosis |journal=Curr. Opin. Neurol. |volume=28 |issue=3 |pages=193–205 |year=2015 |pmid=25887774 |doi=10.1097/WCO.0000000000000206 |url=}}</ref>
-;'''Relapsing-remitting'''
+* Another associated termination regarding [[MS]] classification is "radiologic<nowiki/>ally isolated syndrome (RIS)." It defines as [[radiological]] findings of [[myelin sheath]] [[inflammation]] without any [[Sign (medical)|sign]] or [[Symptoms|symptom]]<nowiki/>s in patient. RIS can be an indicator of early stage<nowiki/>s of [[Multiple sclerosis|MS]] disease, but  it's not a subgroup of [[Multiple sclerosis|MS]] because [[radiological]] finding of [[Inflammation|inflammatory]] [[demyelination]] without any [[Sign (medical)|sign]] or [[symptoms]] of the [[disease]] is nonspecific.<ref name="pmid24871874" />
-[[RRMS]] in defined by acute attacks of [[neurological]] [[dysfunction]] followed by full or partial [[recovery]]. Patient clinical [[symptoms]] are stable between the attacks.<ref name=":0" />
-;'''Secondary progressive'''
-;   '''Primary progressive'''
-;   '''Progressive relapsing'''
-;
-: These subtypes were defined In 1996 by the US National Multiple Sclerosis Society (NMSS).<ref name=":0" />
-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 [[McDonald criteria|criteria]] for multiple sclerosis.<ref name="pmid15847841">{{cite journal |author=Miller D, Barkhof F, Montalban X, Thompson A, Filippi M|title=Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis |journal=Lancet neurology |volume=4 |issue=5 |pages=281–8 |year=2005 |pmid=15847841|doi=10.1016/S1474-4422(05)70071-5}}</ref> Several studies have shown that starting treatment with [[interferon]]s during the initial attack can decrease the chance that a patient will develop MS.<ref>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</ref><ref>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</ref><ref name="pmid17679016">{{cite journal |author=Kappos L, Freedman MS, Polman CH, ''et al'' |title=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 |journal=Lancet |volume=370 |issue=9585|pages=389–97 |year=2007 |pmid=17679016 |doi=10.1016/S0140-6736(07)61194-5}}</ref>
-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 [[Devic's disease|Neuromyelitis optica]] (NMO), [[Balo concentric sclerosis]], [[Schilder disease|Schilder's diffuse sclerosis]] and [[Marburg multiple sclerosis]].<ref>Borderline forms of MS, Fontaine, B., Federation de Neurologie, INSERM U546, Groupe Hospitalier, Faculte de Medecine Pitie-Salpetriere, Paris [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11787357&query_hl=15&itool=pubmed_docsum]</ref>
 ==References==
 {{reflist|2}}
+{{WH}}
+{{WS}}
-[[Category:Primary care]]
 [[Category:Neurology]]
 [[Category:Orthopedics]]
 [[Category:Rheumatology]]
-{{WH}}
-{{WS}}