Defining the clinical course of multiple sclerosis
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Abstract
Accurate clinical course descriptions (phenotypes) of multiple sclerosis (MS) are important for communication, prognostication, design and recruitment of clinical trials, and treatment decision-making. Standardized descriptions published in 1996 based on a survey of international MS experts provided purely clinical phenotypes based on data and consensus at that time, but imaging and biological correlates were lacking. Increased understanding of MS and its pathology, coupled with general concern that the original descriptors may not adequately reflect more recently identified clinical aspects of the disease, prompted a re-examination of MS disease phenotypes by the International Advisory Committee on Clinical Trials of MS. While imaging and biological markers that might provide objective criteria for separating clinical phenotypes are lacking, we propose refined descriptors that include consideration of disease activity (based on clinical relapse rate and imaging findings) and disease progression. Strategies for future research to better define phenotypes are also outlined.
GLOSSARY
- CIS=
- clinically isolated syndrome;
- EDSS=
- Expanded Disability Status Scale;
- MS=
- multiple sclerosis;
- NMSS=
- National Multiple Sclerosis Society;
- OCT=
- optical coherence tomography;
- PP=
- primary progressive;
- PR=
- progressive relapsing;
- PRO=
- patient-reported outcomes;
- RIS=
- radiologically isolated syndrome;
- RR=
- relapsing-remitting;
- SP=
- secondary progressive
Footnotes
F.D.L., S.C.R., J.A.C., G.R.C., P.S.S., A.J.T., J.S.W., L.J.B., B. Banwell, F.B., P.A.C., M.C., G.C., M.S.F., A.D.G., L.K., B.C.K., C.L., A.E.M., X.M., P.W.O., J.P., C.P., M.P.S., O.S., and C.H.P. are members of the International Advisory Committee on Clinical Trials in Multiple Sclerosis.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing Charge was paid by the International Advisory Committee on Clinical Trials in Multiple Sclerosis with funds provided by the European Committee for Treatment and Research in Multiple Sclerosis and the National Multiple Sclerosis Society (USA).
Editorial, page 206
- Received October 22, 2013.
- Accepted in final form February 26, 2014.
- © 2014 American Academy of Neurology
This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivative 3.0 License, which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
Letters: Rapid online correspondence
- Re:Mutiple sclerosis subtypes or not
- Fred D. Lublin, Professor of Neurology, Icahn School of Medicine at Mount Sinaifred.lublin@mssm.edu
Submitted November 20, 2014 - Mutiple sclerosis subtypes or not
- Francois H Jacques, neurologist, Clinique Neuro-Outaouaisfrancois.jacques@neuro-outaouais.ca
Submitted November 12, 2014 - A problem with consensus
- Richard B. Tenser, Physician, Penn State University College of Medicinertenser@psu.edu
- Hershey, PA
Submitted August 22, 2014
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