Multiple sclerosis classification: Difference between revisions

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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.

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[: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.

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[2]

[3]

@@ Line 5: / Line 5: @@
 ==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.<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>
+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" />
+* 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 clinical manifestations.<ref name=":0" />
+* 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.<ref name="pmid24871874" />
+* 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;" |Acute Motor Axonal Neuropathy (AMAN)
+! style="background: #DCDCDC; text-align: center;" |'''Relapsing remitting'''
 | style="background: #F5F5F5;" |
-* The most common type (85-90%).
+* 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
-* Prior infection can trigger it.
-* [[Autoimmune disorder]].
-* The target is [[schwann cell]] surface membrane or the [[myelin]].
-* Causes [[demyelination]].
-* In electrodiagnostic tests we can see slowing of nerve conduction.
-* In pathology we can see [[Lymphocyte|lymphocytic]] infiltration of peripheral nerves and [[macrophage]] invasion of [[myelin sheath]] and [[Schwann cell|schwann cells]].
 |-
-! style="background: #DCDCDC; text-align: center;" |Acute Motor Axonal Neuropathy (AMAN)
+! style="background: #DCDCDC; text-align: center;" |'''Secondary progressive'''
 | style="background: #F5F5F5;" |
-* It’s common among Chinese and Japanese people.
+* Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the [[neurological]] [[symptoms]] progressively worsen between the attacks
-* It can be triggered by C. jejuni.
-* It is associated with anti[[ganglioside]] [[antibodies]].
-* [[Autoimmunity|Autoimmune]] disorder.
-* Target is [[Axon|axonal]] membrane.
-* Causes [[Axon|axonal]] degeneration in [[Motor neuron|motor neurons]].
-* In electrodiagnostic study we can see reduction of compound muscle [[action potential]].
 |-
-! style="background: #DCDCDC; text-align: center;" |Acute motor and sensory axonal neuropathy
+! style="background: #DCDCDC; text-align: center;" |'''Primary progressive'''
 | style="background: #F5F5F5;" |
-* The incidence rate is under 10%.
+* Primary progressive multiple sclerosis (PPMS) is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks and [[remission]]<nowiki/>s
-* Causes [[Axon|axonal]] [[degeneration]].
-* It is similar with [[Acute motor axonal neuropathy|AMAN]] but involves both motor and sensory [[Axon|axons]].
 |-
-! style="background: #DCDCDC; text-align: center;" |Miller Fisher syndrome
+! style="background: #DCDCDC; text-align: center;" |'''Progressive relapsing'''
 | style="background: #F5F5F5;" |
-* Causes a clinical triad: [[ophthalmoplegia]], [[ataxia]] and [[areflexia]].
+* Progressive relapsing multiple sclerosis (PRMS) is defined by progression of [[disease]] from the beginning with acute attack episodes
-* Associated with [[ganglioside]] GQ1b [[antibody]].
 |}
-** '''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.<ref name=":0" />
-** '''Secondary progressive:''' Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the [[neurological]] [[symptoms]] progressively worsen between the attacks.<ref name=":0" />
-** <nowiki/> '''Primary progressive:''' Primary progressive multiple sclerosis (PPMS) is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks and [[remission]]<nowiki/>s.<ref name=":0" />
-** '''Progressive relapsing:''' Progressive relapsing multiple sclerosis (PRMS) is defined by progression of [[disease]] from the beginning with acute attack episodes.<ref name=":0" />
 === Other new multiple sclerosis subclasses ===
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