scholarly journals The significance of time stages in different types of multiple sclerosis course for the formation of prognosis

2021 ◽  
Vol 17 (7) ◽  
pp. 5-10
Author(s):  
N.P. Voloshyna ◽  
V.V. Vasylovskyy ◽  
T.V. Negreba ◽  
V.M. Kirzhner ◽  
I.K. Voloshyn-Haponov ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Permutation Test ◽  
Progressive Multiple Sclerosis ◽  
Preclinical Stage ◽  
Clinical Indicators ◽  
Primary Progressive ◽  
Secondary Progressive ◽  
Relapsing Remitting ◽  
Different Types ◽  
Progressive Course

Background. The purpose was to develop a prognosis assessment system based on clinical and mathematical analysis of indicators at different stages in various types of the course of multiple sclerosis. Materials and methods. Clinical (clinical neurological method and survey using a questionnaire developed at the Department of Autoimmune and Degenerative Pathology of the Nervous System of the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”) and mathematical and statistical (permutation test) methods were applied. Using the method of permutation (permutation test) in groups of patients with different types of multiple sclerosis, the differences in the mean values of clinical indicators were evaluated characterizing the type of multiple sclerosis course at different time stages: preclinical stage, the onset, recurrent stage for relapsing-remitting and secondary progressive multiple sclerosis, stage of progression — for secondary and primary progressive multiple sclerosis. On this basis, clinical indicators were identified, which with a high probability (confidence interval of 0.95) at each time stage of multiple sclerosis determine the final prognosis of the disease. Results. We have examined 280 patients: 80 (50 women and 30 men) with a relapsing-remitting course, 140 (80 women and 60 men) with a secondary progressive course and 60 (30 women and 30 men) with a primary progressive course of multiple sclerosis. The nature of prognosis (good and uncertain with a relapsing-remitting course, uncertain and poor with progressive types) was assessed on the basis of clinical and diagnostic criteria developed taking into account the features of the disease course as a whole. The studies have shown that a good prognosis is highly probable with a combination of clinical indicators such as mild onset, complete remission after onset, mild relapses developing rapidly, and long-term remission between relapses at a relapsing-remitting stage; uncertain prognosis — in the presence of moderate onset, stem symptoms at the onset, severe and moderate relapses, and a tendency to aggravate and lengthen relapses at a relapsing-remitting stage. A poor prognosis in a secondary progressive course is reliably associated with the chickenpox at the preclinical stage in a premorbid history, lightning-fast onset development, steady progression proceeding without clinically outlined periods of stabilization; uncertain prognosis — with a fast development of the onset. A poor prognosis in a primary progressive course was closely associated with severe traumatic brain injury at the preclinical stage in a premorbid history, cerebellar symptoms at the onset, formation of the progression stage immediately after the onset, without the stabilization period, steady type of progression at the stage of progression; uncertain prognosis — with herpetic infections at the preclinical stage in a premorbid history, mild onset, the formation of a progression stage after a stabilization period that occurred after the onset, incremental progression at the progression stage proceeding in the form of alternating periods of slow accumulation of neurological deficit, which, as a rule, has a local focus, and stages of stabilization with different duration. Conclusions. Thus, with the help of clinical and mathematical analysis, it was shown that the formation of alternative prognosis variants for different types of multiple sclerosis occurs through a selective involvement in a single pattern of clinical indicators that have diagnostic significance at different time stages of the course of the disease.

scholarly journals Secondary Progression is Not the Only Explanation

2014 ◽  
Vol 27 (3) ◽  
pp. 393 ◽  
Author(s):  
Filipe Palavra ◽  
Carmen Tur ◽  
Mar Tintoré ◽  
Àlex Rovira ◽  
Xavier Montalban
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Skills ◽  
Progressive Multiple Sclerosis ◽  
Clinical Expertise ◽  
Secondary Progressive ◽  
Demyelinating Disorder ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Red Flag ◽  
Progressive Course

<p>Multiple sclerosis is an inflammatory demyelinating disorder of the central nervous system. Its presentation is variable and its course and prognosis are unpredictable. Approximately 85% of individuals present a relapsing-remitting form of the disease, but some patients may evolve into a progressive course, accumulating irreversible neurological disability, defining its secondary progressive phase. Despite all the advances that had been reached in terms of diagnosis, many decisions are still taken based only on pure clinical skills. We present the case of a patient that, after being diagnosed with a clinically isolated syndrome many years ago, seemed to be entering in a secondary progressive course, developing a clinical picture dominated by a progressive gait disturbance. Nevertheless, multiple sclerosis heterogeneity asks for some clinical expertise, in order to exclude all other possible causes for patients’ complaints. Here we present an important red flag in the differential diagnosis of secondary progressive multiple sclerosis.<br /><strong>Keywords:</strong> Magnetic Resonance Imaging; Multiple Sclerosis, Chronic Progressive; Meningioma.</p>

Primary progressive multiple sclerosis: a distinct syndrome?

1996 ◽  
Vol 2 (3) ◽  
pp. 137-141 ◽  
Author(s):  
GV McDonnell ◽  
SA Hawkins
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Disease ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Progressive Decline ◽  
Primary Progressive ◽  
Therapeutic Trials ◽  
Relapsing Remitting ◽  
Progressive Course

Multiple sclerosis (MS) has long been recognised to have both a relapsing-remitting and progressive course. More recently patients with progressive disease have been further sub-divided into those with a progressive course from onset (primary progressive MS) and those with progressive decline following an initially relapsing-remitting period (secondary progressive MS). Diversity in MS may not however be restricted to clinical course. There is growing evidence that the subgroups of MS also differ with respect to clinical features, epidemiology, pathogenesis, genetics and neuroimaging appearances. In this review we outline the criteria variously applied in the classification of MS patients, addressing the need for a dear nomenclature. We evaluate the proposition that primary progressive MS has a prof ile distinct from other MS categories, contrasting the separate differential diagnoses and examining the implications for future therapeutic trials.

The pathology of primary progressive multiple sclerosis

2002 ◽  
Vol 8 (2) ◽  
pp. 93-97 ◽  
Author(s):  
W Brück ◽  
C Lucchinetti ◽  
H Lassmann
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Current Knowledge ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
Secondary Progressive ◽  
Relapsing Remitting ◽  
Underlying Pathology ◽  
Clinical Subtype

The present review will focus on the current knowledge of the pathology of primary progressive multiple sclerosis lesions. Multiple sclerosis (MS) is an inflammatory demyelinating disease with a broad clinical variability. The main disease courses are relapsing-remitting, secondary progressive and primary progressive MS. Pathological studies examining the specific underlying pathology of a defined clinical subtype are rare. Here, we focus on the phatological characteristics of the MS lesions and summarize the current findings of the phatology of primary progressive MS with respect to inflammation, oligodendrocyte/myelin pathology, axon destruction and immunopathology of the lesions.

Primary progressive multiple sclerosis: cerebrospinal fluid considerations

2004 ◽  
Vol 10 (3_suppl) ◽  
pp. S31-S35
Author(s):  
Mark S Freedman
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
State Of The Art ◽  
Disease Process ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
Secondary Progressive ◽  
Current State ◽  
Relapsing Remitting

Diagnosing the ‘primary progressive’ form of multiple sclerosis (PPMS) requires assurance that other conditions that might cause a chronic inflammatory neurodegenerative central nervous system (CNS) disease have been ruled out. Both imaging and pathological studies have shown that this form of MS tends to be less inflammatory compared with either the relapsing-remitting or secondary progressive types. There are therefore many conditions that cause a slowly progressive wasting of the C NS that might be confused with MS. The new MS diagnostic scheme has made the presence of ‘typical’ MS abnormalities in the cerebrospinal fluid (C SF) a mandatory first criterion, but there may well be individuals that still have PPMS even in the absence of a typical MS C SF. Here we explore what the C SF can tell about an individual’s disease process and outline the current state of the art in terms of C SF analysis. Used properly, the C SF can be very helpful in clarifying a diagnosis of PPMS.

The pathology of primary progressive multiple sclerosis

2004 ◽  
Vol 10 (3_suppl) ◽  
pp. S23-S30 ◽  
Author(s):  
Claudia Lucchinetti ◽  
Wolfgang Bruck
Keyword(s):  
Multiple Sclerosis ◽  
Axonal Injury ◽  
Treatment Strategies ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Limited Information ◽  
Primary Progressive ◽  
Secondary Progressive ◽  
Relapsing Remitting ◽  
Focal Demyelination

The patho logical hallmark of chronic multiple sclerosis includes focal demyelination, gliosis, inflammation and axonal injury. There is limited information on whether these pathological features differ across the clinical pheno types of the disease (relapsing-remitting, secondary progressive, and primary progressive). This review will focus on the patho logical aspects of PPMS and pathogenic implications. A better understanding of the differences in PPMS pathology and patho genesis will lead to more effective treatment strategies.

scholarly journals Kallikreins are associated with secondary progressive multiple sclerosis and promote neurodegeneration

2008 ◽  
Vol 389 (6) ◽  
Author(s):  
Isobel A. Scarisbrick ◽  
Rachel Linbo ◽  
Alexander G. Vandell ◽  
Mark Keegan ◽  
Sachiko I. Blaber ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cortical Neurons ◽  
Serine Proteases ◽  
Serum Levels ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Neurite Retraction ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Potential Activity

Abstract Tissue kallikrein KLK1 and the kallikrein-related peptidases KLK2–15 are a subfamily of serine proteases that have defined or proposed roles in a range of central nervous system (CNS) and non-CNS pathologies. To further understand their potential activity in multiple sclerosis (MS), serum levels of KLK1, 6, 7, 8 and 10 were determined in 35 MS patients and 62 controls by quantitative fluorometric ELISA. Serum levels were then correlated with Expanded Disability Status Scale (EDSS) scores determined at the time of serological sampling or at last clinical follow-up. Serum levels of KLK1 and KLK6 were elevated in MS patients (p≤0.027), with highest levels associated with secondary progressive disease. Elevated KLK1 correlated with higher EDSS scores at the time of serum draw and KLK6 with future EDSS worsening in relapsing remitting patients (p≤0.007). Supporting the concept that KLK1 and KLK6 promote degenerative events associated with progressive MS, exposure of murine cortical neurons to either kallikrein promoted rapid neurite retraction and neuron loss. These novel findings suggest that KLK1 and KLK6 may serve as serological markers of progressive MS and contribute directly to the development of neurological disability by promoting axonal injury and neuron cell death.

scholarly journals Onset of secondary progressive multiple sclerosis is not influenced by current relapsing multiple sclerosis therapies

2018 ◽  
Vol 4 (2) ◽  
pp. 205521731878334 ◽  
Author(s):  
Francisco Coret ◽  
Francisco C Pérez-Miralles ◽  
Francisco Gascón ◽  
Carmen Alcalá ◽  
Arantxa Navarré ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Disease Modifying Therapies ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis

Background Disease-modifying therapies are thought to reduce the conversion rate to secondary progressive multiple sclerosis. Objective To explore the rate, chronology, and contributing factors of conversion to the progressive phase in treated relapsing–remitting multiple sclerosis patients. Methods Our study included 204 patients treated for relapsing–remitting multiple sclerosis between 1995 and 2002, prospectively followed to date. Kaplan–Meier analysis was applied to estimate the time until secondary progressive multiple sclerosis conversion, and multivariate survival analysis with a Cox regression model was used to analyse prognostic factors. Results Relapsing–remitting multiple sclerosis patients were continuously treated for 13 years (SD 4.5); 36.3% converted to secondary progressive multiple sclerosis at a mean age of 42.6 years (SD 10.6), a mean time of 8.2 years (SD 5.2) and an estimated mean time of 17.2 years (range 17.1–18.1). A multifocal relapse, age older than 34 years at disease onset and treatment failure independently predicted conversion to secondary progressive multiple sclerosis but did not influence the time to reach an Expanded Disability Status Scale of 6.0. Conclusions The favourable influence of disease-modifying therapies on long-term disability in relapsing–remitting multiple sclerosis is well established. However, the time to progression onset and the subsequent clinical course in treated patients seem similar to those previously reported in natural history studies. More studies are needed to clarify the effect of disease-modifying therapies once the progressive phase has been reached.

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