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{{Template:Multiple sclerosis}}
{{Template:Multiple sclerosis}}


{{CMG}}
{{CMG}}; {{AE}} {{Fs}}


==Overview==
==Overview==
Multiple sclerosis may be classified into four groups according to [[clinical]] course of the [[disease]] including: Relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing.<ref name=":0" />
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==
==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 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>
=== 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:''' ====
RRMS is 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:''' ====
Patient with long term RRMS can switch to SPMS, when the [[neurological]] [[symptoms]] progressively worsen between the attacks.<ref name=":0" />
 
==== '''Primary progressive:''' ====
PPMS is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks and [[remission]]<nowiki/>s.<ref name=":0" />
 
==== '''Progressive relapsing:''' ====
PRMS is defined by progression of [[disease]] from the beginning with acute attack episodes.<ref name=":0" />
 
These subtypes were defined in 1996 by the US [[National Multiple Sclerosis Society]] (NMSS).<ref name=":0" /> 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.<ref name="pmid24871874" />
 
In recent studies a new subtype recognized and named: 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>


Another termination that we have 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. Although it can be an indicator of early stage<nowiki/>s of [[Multiple sclerosis|MS]] disease, we cannot consider it as 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" />
* 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" />


==References==
==References==


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[[Category:Primary care]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Orthopedics]]
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Latest revision as of 22:47, 29 July 2020

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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

Subtypes Explanation
Relapsing remitting
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
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

References

  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
  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.
  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.

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