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.

[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
+|}
-[[Image:Types of MS-2.jpg|thumb|400px|right|Graph representing the different types of multiple sclerosis]]
+=== Other new multiple sclerosis subclasses ===
-The course of MS is difficult to predict, and the disease may at times either lie dormant or progress steadily. Several subtypes, or patterns of progression, have been described. Subtypes use the past course of the disease in an attempt to predict the future course. Subtypes are important not only for [[prognosis]] but also for therapeutic decisions. In 1996 the United States [[National Multiple Sclerosis Society]] standardized the following four subtype definitions:<ref>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>
+* 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
-: Relapsing-remitting describes the initial course of 85% to 90% of individuals with MS. This subtype is characterized by unpredictable attacks ([[relapse]]s) followed by periods of months to years of relative quiet ([[remission (medicine)|remission]]) with no new signs of disease activity. Deficits suffered during the attacks may either resolve or may be permanent. When deficits always resolve between attacks, this is referred to as "[[benign]]" MS.
-; Secondary progressive
-: Secondary progressive describes around 80% of those with initial relapsing-remitting MS, who then begin to have neurologic decline between their acute attacks without any definite periods of remission. This decline may include new neurologic symptoms, worsening [[neurocognitive|cognitive]] function, or other deficits.  Secondary progressive is the most common type of MS and causes the greatest amount of [[disability]].
-; Primary progressive
-: Primary progressive describes the approximately 10% of individuals who never have remission after their initial MS symptoms. Decline occurs continuously without clear attacks. The primary progressive subtype tends to affect people who are older at disease onset.
-; Progressive relapsing
-: Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes
-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>
+* 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==
 {{reflist|2}}
 {{WH}}
 {{WS}}
+[[Category:Neurology]]
+[[Category:Orthopedics]]
+[[Category:Rheumatology]]